SPINAL DEFORMITIES - Weebly

SPINAL DEFORMITIES NORMAL SPINE ALLIGNMENT FRONTAL PLANE STRAIGHT LATERAL PLANE

20-40 DEGREE THORACIC KYPHOSIS 30-60 DEGREE LUMBAR LORDOSIS SCOLIOSIS

Def. Lat. deviation of the spine from midline with rotation

Rotation in scoliosis SCOLIOSIS Types : Congenital (structural abn. In vertebrae

or ribs ) Neuromuscular (eg. Cerebral palsy, spinal muscular atrophy) Idiopathic (most common ) Others CONGENITAL

CLASSIFICATION Wedge vertebrae Hemivertebrae Unilateral

Block Bar vertebrae vertebrae IDIOPATHIC SCOLIOSIS Spinal deformity in a spine which was normal Causes

? Properioception disorders Brain stem Melatonin hormones UNKNOWN IDIOPATHIC SCOLIOSIS

TYPES Infantile Juvenile (0-4 yrs ) (4-9 yrs )

Adolescent (> 10 yrs ) [most common] IDIOPATHIC SCOLIOSIS Incidence More in female Rt thoracic curve is the most

common ? Family Hx More in twins IDIOPATHIC SCOLIOSIS

Complications : Loss of self image Family observation Pain Early fatigue Cardio-pulmonary dysfunction ( if curve

> 90 ) IDIOPATHIC SCOLIOSIS On Examination :

Shoulder level inequality Waist line asymmetry Spinal deformity

Rib hump Adam foreword flexion test Full neurological exam clinically IDIOPATHIC SCOLIOSIS

Radiological exam : X-rays : AP LAT standing long film AP supine AP Pelvis LAT spine

IDIOPATHIC SCOLIOSIS MRI : If abnormal curve suspected Ct scan :

If congenital scoliosis suspected X-ray 71 53

Cobb and Lippmann Determine end vertebrae Those most tilted

from horizontal Line along upper end plate prox. & lower endplate distally

Measure formed angle Transitional vertebrae Treatment

Based on : 1. Maturity of the pt.

Menarche Rissers sign 2. Magnitude of deformity 3. Curve

progression Rissers stage eg. Treatment Options 1.Observation

2.Bracing 3.Surgery ? Physical therapy & exercise Treatment ( protocol ) Mature pt.

< 50 observation progression ~ 1 / year > 50 surgery

Immature pt. 0-25 Observation every 4-6 months clinically &

radiologically 25-40 > 40 Bracing Surgery

Braces eg. Treatment Braces : Did not correct the deformity Might stop the progression of the curve

(or slow it down) Effect is dose related (more worn better effect)

Best 23 hours / day If curve apex above T7 Milwaukee brace If curve apex bellow T8 Boston brace

Milwaukee brace Boston brace Treatment Surgery :

Anterior spinal fusion severe curve young pt. < 10 years Post spinal fusion & instrumentation

The gold standard treatment for most of cases Both For selected cases Treatment

Complications of surgery Neurological deficit Bleeding Infection Pseudoarthrosis Crank shaft phenomena

Examples

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