Transcript Postural Scoliosis

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.
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 @ prolapsed lumbar disc
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.
Types of Structural Scoliosis
Idiopathic scoliosis
80%
1. Infantile <3yrs
2. Juvenile 4-9 yrs
3. Adolescent
>10yrs (Most
common)
Scoliosis due to known causes 20%
1. Osteopathic: due to Congenital
vertebral anomalies. Rare but
dangerously progressive
2. 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
Patterns of Idiopathic Scoliosis
Infantile thoracic:
A.
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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:
B.
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90% female
90% convex to the right
Rib rotation exaggerates the deformity
50% develop curves of greater than 70˚
C.
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D.
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E.
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
Combined:
Two primary curves, one in each direction. Even when
radiologically severe, clinical deformity relatively slight
because always well balanced.
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)
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:
o Skin for café au lait spots indicative of
neurofibromatosis
o The feet for cavovarus deformity
o Abdominal reflexes
o Muscle tone for spasticity
o The patient's gait is assessed
o 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 Xray.
• A scolie is an X-ray taken from the
rear.
• An AP-Lateral is taken from the side.
Cobb’s 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.
Cobb’s Angle
Treatment
The aim:
o prevent the curve becoming severe
o 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 <30 degree , treatment is
unnecessary (Only exercises).
• If the curve b/w 20 – 30 degree and in
progression a support as Milwaukee brace is
needed:
o Thoracic support consisting of pelvic corset
connected by adjustable steel supports to a
cervical ring carrying occipital and chin pads
o Its purpose is to reduce the lumbar lordosis
and encourage active stretching and
straightening of thoracic spine .
Surgical Treatment
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The aim of surgery is to:
 Reduce deformity
 Maintain
reduction by arthrodesis (The
surgical immobilization of a joint (joint fusion).
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Indications:
 Curves >30 degree with progression
 Milder curves that deteriorate significantly
despite conservative treatment
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 wellrecognized deformity which may be
progressive
Classification
Postural kyphosis
It is common (‘round back’ or ‘drooping shoulders’) and
may be associated with other postural defects such as flatfeet
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 scheuermann’s disease (adolescent
kyphosis)
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