basics of spinal deformity البروفيسور فريح ابوحسان- استشاري جراحة...

Professor of Orthopaedics

1/15/2011 ١Professor Freih Abuhassan -University of Jordan

1/15/2011 ٢Professor Freih Abuhassan -University of Jordan

1/15/2011 ٣Professor Freih Abuhassan -University of Jordan

1/15/2011 ٤Professor Freih Abuhassan -University of Jordan

1/15/2011 ٥Professor Freih Abuhassan -University of Jordan

1/15/2011 ٦Professor Freih Abuhassan -University of Jordan

• Scoliosis:• Scoliosis: Lateral curvature of the spine.Lateral curvature of the spine. (reversible lateral curvature with out rotation) !!!!!!!rotation) !!!!!!!

• Structural Scoliosis:Irreversible lateral curvature of the spine withrotation of the vertebral bodies in the area of the

major curve. 3D

1/15/2011 ٧Professor Freih Abuhassan -University of Jordan

• Major curve:• Major curve: Th l lThe largest structural curve.

C t• Compensatory curve: A h i b b l jA curve that is above or below a major

curve that serves to maintain normal body alignment.1/15/2011 ٨Professor Freih Abuhassan -

University of Jordan

1/15/2011 ٩Professor Freih Abuhassan -University of Jordan

1/15/2011 ١٠Professor Freih Abuhassan -University of Jordan

Frontal plane (X-ray)Frontal plane (X ray) *< 10 degrees of lateral spinal

d i tideviation *< 2 cm of trunk shift level

pelvis & shoulders

1/15/2011 ١١Professor Freih Abuhassan -University of Jordan

Sagittal planeSagittal planeThoracic spineKyphosis : 25 - 45 deg.

Thoracolumbar junction 10 10 d-10 to +10 degrees

lumbar spine l d i 25 t 65 dlordosis 25 to 65 deg.

1/15/2011 ١٢Professor Freih Abuhassan -University of Jordan

lateral deviation of the spine?! with measured curvature of greater thancurvature of greater than 10 degrees on

di hi l iradiographic analysis

1/15/2011 ١٣Professor Freih Abuhassan -University of Jordan

1/15/2011 ١٤Professor Freih Abuhassan -University of Jordan

1/15/2011 ١٥Professor Freih Abuhassan -University of Jordan

1/15/2011 ١٦Professor Freih Abuhassan -University of Jordan

1/15/2011 ١٧Professor Freih Abuhassan -University of Jordan

Crooked tree

1/15/2011 ١٨Professor Freih Abuhassan -University of Jordan

1/15/2011 ١٩Professor Freih Abuhassan -University of Jordan

G CGreek = CrookedIst used by Galen 131 201 A DIst used by Galen 131-201 A.D

1/15/2011 ٢٠Professor Freih Abuhassan -University of Jordan

Prevalence of Scoliosis

School screeningSchool screening

Physical exam 8-10% suspicious! y p1.1% to 4.1% X-ray confirmed

li i F/M ti 5 10 1scoliosis F/M ratio 5-10:1

1/15/2011 ٢١Professor Freih Abuhassan -University of Jordan

Structural Idiopathic Neuromuscular CongenitalCongenital MetabolicMetabolic Tumor, Trauma

1/15/2011 ٢٢Professor Freih Abuhassan -University of Jordan

Non-structuralPosturalLLDLLD InflammatoryInflammatory Infection Tumor

1/15/2011 ٢٣Professor Freih Abuhassan -University of Jordan

Eti l f S li iEtiology of Scoliosis

Idiopathic: no single clear etiology*G i*Genetic – familial prevalence, twins *Hormonal – progressive forms much more

common in females. *Connective tissue – histologic changes in

apical tissues, cause or effect ? *CNS – proprioceptive dysfunction*Neuromuscular

1/15/2011 ٢٤Professor Freih Abuhassan -University of Jordan

1-Spinous process deviates toward thep pconcave side.

2 The vertebral body rotates toward2-The vertebral body rotates toward the convex side.

3-Ribs become closer together on the concave side and separated on theconcave side and separated on the convex side.

1/15/2011 ٢٥Professor Freih Abuhassan -University of Jordan

1/15/2011 ٢٦Professor Freih Abuhassan -University of Jordan

Pathophysiology ?Pathophysiology ?S i l thSpinal growthLigamentous laxity, hormonal changes

–Rotational deformation–Rotational deformation –Progressive

•rotation •translation•translation, •complex 3D deformity

1/15/2011 ٢٧Professor Freih Abuhassan -University of Jordan

1/15/2011 ٢٨Professor Freih Abuhassan -University of Jordan

Muscle Power Testing (MRC Scale

0 Total paralysisp y1 Barely detectable contracture2 N t h t t i t it2 Not enough to act against gravity3 Strong enough to act against gravity3 Strong enough to act against gravity4 Still stronger but less than normal5 Full power

1/15/2011 ٢٩Professor Freih Abuhassan -University of Jordan

1/15/2011 ٣٠Professor Freih Abuhassan -University of Jordan

Imaging for spinal problemsImaging for spinal problemsComputed tomography (with myelo.)Computed tomography (with myelo.)Plain x-rays

AP d l t l i– AP and lateral views– Oblique views – PA view in females !!!!!

MR imagingMR imagingRadioisotope scanningDi h & f t j i t th hDiscography & facet joint arthrography

1/15/2011 ٣١Professor Freih Abuhassan -University of Jordan

Ca da Eq ina S ndromeCauda Equina Syndrome

Large midline compression e.g discCompresses several nerve rootsSphincter disturbanceSaddle anaesthesiaSaddle anaesthesiaPrompt surgical interventionp g

1/15/2011 ٣٢Professor Freih Abuhassan -University of Jordan

S d l li th iSpondylolisthesis

Forward slippage of one vertebralone vertebral body on another

1/15/2011 ٣٣Professor Freih Abuhassan -University of Jordan

KyphosisKyphosis

Sagittal plane deformity in the thoracic or thoracolumbar spine

Postural (Round back)CompensatoryStructural

1/15/2011 ٣٤Professor Freih Abuhassan -University of Jordan

1/15/2011 ٣٥Professor Freih Abuhassan -University of Jordan

1/15/2011 ٣٦Professor Freih Abuhassan -University of Jordan