Comprehensive assessment of the morpho-functional state of the back skin integument in adolescents with idiopathic scoliosis

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Abstract

BACKGROUND: In the formation of scoliotic deformity of the spinal column, the skin of the back on the protruding parts of the body is a vulnerable area. However, the study of the characteristics of the skin condition of the back of adolescents with idiopathic scoliosis has not been given due attention.

AIM: To conduct a comprehensive assessment of the morphological and functional properties of the skin of the back of adolescents with idiopathic scoliosis and to determine the information content of the research methods used.

MATERIALS AND METHODS: In 20 adolescents with idiopathic scoliosis, the skin of the back was examined. The following methods were used: visual clinical examination, local thermometry, laser Doppler flowmetry, esthesiometry, elastometry, histological methods.

RESULTS: Visually, in 70% of cases, a change in the skin was revealed. In the region of the spinal deformity apex, the skin temperature was higher on the convex side than on the concave side. In the skin of the paravertebral region, capillary blood flow from the convex side and in the distal spine was more intense than on the concave side. In the dermatomes corresponding to the apex of the deformity, hyperesthesia, hypesthesia, and the absence of thermal sensitivity were noted. In the paravertebral and scapular projections, in the region of the deformity apex, the lowest indicators of skin elasticity were recorded, compared with the areas located above and below. Histostructural differences in the skin were revealed in the area of the convex and concave sides of the apex of the deformity. On the convex side, a significant decrease in the thickness of the epidermis and dermis, an increase in the thickness of the subcutaneous fat, a greater severity of reactive-destructive changes in the fibrous, vascular and innervating components of the dermis were determined.

CONCLUSIONS: The use of an integrated approach in the study of the skin of the back of adolescents with idiopathic scoliosis made it possible to identify the features of structural and functional changes, which indicates the information content of the selected methods. The results obtained must be taken into account when planning the treatment and rehabilitation process of patients with this pathology.

About the authors

Alina P. Gorbach

National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Email: alinatomilova@mail.ru
ORCID iD: 0000-0001-7788-2687
SPIN-code: 6127-8754

postgraduate

Russian Federation, Kurgan

Еlena N. Shurova

National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Email: elena.shurova@mail.ru
ORCID iD: 0000-0003-0816-1004
SPIN-code: 6919-1265
Scopus Author ID: 6602428322

Dr. Sci. (Biol.), Professor of the Department of Traumatology, Orthopedics and Related Disciplines, Leading Research Associate of the Scientific Laboratory of the Clinic of the Spine and Rare Diseases

Russian Federation, Kurgan

Elena N. Gorbach

National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Author for correspondence.
Email: gorbach.e@mail.ru
ORCID iD: 0000-0002-9516-7481
SPIN-code: 8110-2803
Scopus Author ID: 56107677500
ResearcherId: 9602-2018

Cand. Sci. (Biol.), Leading Research Associate of the Laboratory of the Morphology

Russian Federation, Kurgan

Natalia A. Kononovich

National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Email: n.a.kononovich@mail.ru
ORCID iD: 0000-0002-5990-8908
SPIN-code: 4698-3378

Cand. Sci. (Veterinary), Leading Research Associate of the Experimental Laboratory

Kurgan

Polina V. Ochirova

National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Email: poleen@yandex.ru
ORCID iD: 0000-0003-3249-5063
SPIN-code: 3099-5457

MD, Cand. Sci. (Med.), Traumatologist-Orthopedist, Vertebrologist, Scientific Secretary

Russian Federation, Kurgan

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Supplementary files

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2. Fig. 1. Areas of examination of the skin of the back in adolescents with idiopathic scoliosis (boy, 16 years old). P — paravertebral lines; S — scapular lines, location relative to the apex of the deformity: 1 — proximal; 2 — at the level of the apex of the deformity; 3 — distally. The arrows indicate the sampling sites of intraoperative material for histological examination in the region of the apex of the deformity arc

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3. Fig. 2. Examples of visual changes in the skin of the back of adolescents with idiopathic scoliosis: а — striae; b — pronounced vascular network

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4. Fig. 3. Indicators of local temperature of the skin of the back in the paravertebral projection at the level of various departments in adolescents with idiopathic scoliosis. # The reliability of the difference between the indicators of the concave side from the convex, р < 0.05; * significant differences from the values obtained in the proximal region, р < 0.05

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5. Fig. 4. Features of the histostructural organization of the skin of the back of adolescents with idiopathic scoliosis in the region of the apex of the deformity arc: a — epidermis from the concave side; b — epidermis from the convex side; elastic fibers in the reticular dermis from the concave (c) and convex (d) sides; e — destructive changes in the artery and nerve trunk at the border of the reticular layer of the dermis and hypodermis. Staining: a, b — hematoxylin and eosin; c, d — orcein according to Tenzer–Unn; e — immunohistochemical staining using antibodies to CD34. Magnification ×400

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