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