SCOLIOSIS

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SCOLIOSIS

• A condition that involves complex lateral and
  rotational curvature of the spine.
• Dextroscoliosis is a scoliosis with the
  convexity on the right side.
• Levoscoliosis is a scoliosis with the convexity
  on the left side.

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Classification

• Postural Scoliosis
• The deformity is secondary or compensatory to
  some condition outside the spine when the
  patient sits (thereby cancelling leg asymmetry),
  the curve disappears.
• Conditions that lead to postural scoliosis
• Short leg
• Pelvic tilt due to contracture of the hip
• Local muscle spasm _at_ prolapsed lumbar disc

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Classification

• Structural Scoliosis
• It is always accompanied by bony abnormality or
  vertebral rotation. The deformity is fixed and
  does not disappear with change in posture.
• Secondary curves nearly always develop to
  counterbalance the primary ? later, they may
  become fixed too.

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Types of Structural Scoliosis

• Scoliosis due to known causes 20
• Osteopathic due to Congenital vertebral
  anomalies. Rare but dangerously progressive
• Neuropathic due to asymmetrical muscle weakness
  (e.g. in cerebral palsy and Poliomyelitis)
• 3. Myopathic seen in the rare muscular
  dystrophies
• 4. Neurofibromatosis associated with severe
  deformity

• Idiopathic scoliosis 80
• Infantile lt3yrs
• Juvenile 4-9 yrs
• Adolescent gt10yrs (Most common)

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Patterns of Idiopathic Scoliosis

• Infantile thoracic
• 60 male
• 90 convex to the left
• Associated with ipsilateral plagiocephaly
  (Oblique lateral deformity of the skull )
• May be resolving or progressive(severe)
• Adolescent thoracic
• 90 female
• 90 convex to the right
• Rib rotation exaggerates the deformity
• 50 develop curves of greater than 70

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• Thoracolumbar
• Slightly more common in females
• Slightly more common to right
• Features mid-way between adolescent thoracic and
  lumbar
• Lumbar
• More common in females
• 80 convex to left
• One hip prominent but no ribs to accentuate the
  deformity. Therefore not noticed early, but
  backache in adult life
• E. Combined
• Two primary curves, one in each direction.
  Even when radiologically severe, clinical
  deformity relatively slight because always well
  balanced.

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Clinical features

• The symptoms of scoliosis can include
• Pain is common in adulthood, especially if left
  untreated
• One of the major complaints from parents and
  patients is cosmetic deformity.
• Uneven musculature on one side of the spine
• A rib "hump" and/or a prominent shoulder blade,
  caused by rotation of the ribcage in thoracic
  scoliosis
• Uneven hip and shoulder levels
• Asymmetric size or location of breast in females
• Unequal distance between arms and body
• Clothes that do not "hang right", i.e.. with
  uneven hemlines
• Slow nerve action (in some cases)

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Physical Examination

• Patients who initially present with scoliosis are
  examined to determine if there is an underlying
  cause of the deformity. During a physical
  examination, the following is assessed
• Skin for café au lait spots indicative of
  neurofibromatosis
• The feet for cavovarus deformity
• Abdominal reflexes
• Muscle tone for spasticity
• The patient's gait is assessed
• The back for signs of spina bifida
• The patient is asked to bend forward (Adam's Bend
  Test). If a hump is noted, then scoliosis is a
  possibility and the patient should be sent for an
  x-ray to confirm the diagnosis.

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Investigations

• Many radiologists and doctors when suspecting
  scoliosis will exclaim "scolie and AP-Lateral",
  which are two types of X-ray.
• A scolie is an X-ray taken from the rear.
• An AP-Lateral is taken from the side.

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Cobbs Angle

• Measurement used for evaluation of curves in
  scoliosis on an AP radiographic projection of the
  spine. When assessing a curve, the apical
  vertebra is first identified, the end or
  transitional vertebra are then identified through
  the curve above and below.
• The apical vertebra is most likely displaced and
  rotated vertebra with the least tilted end plate.
  
• The end/transitional vertebra is most superior
  and inferior vertebra which are least displaced
  and rotated and have the maximally tilted end
  plate. A line is drawn along the superior end
  plate of the superior end vertebra and a second
  line drawn along the inferior end plate of the
  inferior end vertebra.

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Cobbs Angle
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Treatment

• The aim
• prevent the curve becoming severe
• correcting the existing deformities
• A period of preliminary observation may be needed
  before deciding between conservative and
  operative treatment.
• At 4-monthly intervals the patient is examined,
  photographed and X-rayed so that the curves can
  be measured and checked for progression.
• School screening should permit early diagnosis
  and regular assessment of the need for active
  treatment.

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Conservative treatment

• If the patient is approaching skeletal maturity
  and the deformity lt30 degree , treatment is
  unnecessary (Only exercises).
• If the curve b/w 20 30 degree and in
  progression a support as Milwaukee brace is
  needed
• Thoracic support consisting of pelvic corset
  connected by adjustable steel supports to a
  cervical ring carrying occipital and chin pads
• Its purpose is to reduce the lumbar lordosis and
  encourage active stretching and straightening of
  thoracic spine .

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Surgical Treatment

• The aim of surgery is to
• Reduce deformity
• Maintain reduction by arthrodesis (The surgical
  immobilization of a joint (joint fusion).
• Indications
• Curves gt30 degree with progression
• Milder curves that deteriorate significantly
  despite conservative treatment

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KYPHOSIS

• Definition
• The term kyphosis is used to describe both
• The normal (the gentle rounding of the dorsal
  spine) and
• The abnormal (excessive dorsal curvature).
• In the latter sense it signifies a
  well-recognized deformity which may be
  progressive

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Classification

• Postural kyphosis
• It is common (round back or drooping
  shoulders) and may be associated with other
  postural defects such as flat-feet
• Structural kyphosis
• Is fixed and associated with changes in the
  shape of the vertebrae. It may occur in
  osteoporosis of the spine (the commonly round
  back of elderly people), in ankylosing
  spondylitis and in scheuermanns disease
  (adolescent kyphosis)

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Kyphos (or Gibbus)

• Is a Sharp posterior angulation due to localized
  collapse or wedging of one or more vertebrae.
  This may be a result of congenital defect, a
  fracture, or spinal tuberculosis

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