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 Hemi- Unilateral Block
vertebrae vertebrae 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 (0-4 yrs )
Juvenile (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
71ْ
53ْ
Cobb and Lippmann
Determine end
vertebrae
Those most tilted
from horizontal
Line along upper end
Transitional
plate prox. & lower vertebrae
endplate distally
Measure formed
angle
Treatment
Based on :
1. Maturity of the pt.
Menarche
Risser’s sign
2. Magnitude of
deformity
3. Curve progression
Risser’s stage eg.
Treatment
Options
1. Observation
2. Bracing
3. Surgery
? Physical therapy & exercise
Treatment ( protocol )
Mature pt.
< 50ْ observation
progression ~ 1ْ / year
> 50ْ surgery
Immature pt.
0-25 ْ Observation every 4-6 months
clinically & radiologically
25-40ْ Bracing
> 40ْ 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
