Scoliosis

Scoliosis

• A condition that involves complex lateral and rotational curvature of the spine.

• The spine is curved and sometimes twisted

• most common type of spinal deformity

• It is seen from behind (the back)

Classification

• The deformity could be:

1)Postural - correctable

2)Structural - fixed

1)Postural scoliosis

The deformity is secondary or compensatory to some condition outside the spine

Disappear with changes in posture (on flexion)No bony abnormalityCondition that lead to postural scoliosis are:

o Short leg (when pt sit cancelling leg asymmetry- curve disappear)

o Pelvic tilt due to contracture of the hipo Local muscle spasm associated with prolapsed lumbar disc

2)Structural scoliosis

• Accompanied by bony abnormality or vertebral rotation

• Deformity is fixed – do not disappear with changes in posture

• Secondary curves develop to counterbalance the primary deformity

• Structural curve becomes more obvious on flexion

Types of structural scoliosis

Idiopathic scoliosis (more common)

1. Infantile <3yrs 2. Juvenile 4-9 yrs 3. Adolescent >10yrs

(most common)

Scoliosis due to known causes1. Osteopathic: is due to

Congenital vertebral anomalies

2. Neuropathic: due to asymmetrical muscle weakness (e.g. in cerebral palsy and Poliomyelitis)

3. Myopathic: in muscular dystrophies

4. Neurofibromatosis

Adolescent idiopathic scoliosis

• Usually present before puberty• Progress until skeletal growth ceases• Cause is unknown• Lateral curvature can occur in the thoracic or lumber

spine.• The vertebra that makes up the curve are rotated

around the vertebral axis i.e. bodies point to the convexity (laterally) and the spinous processes to the concavity of the curve (medially)

• In thoracic curves ribs on the convex side make a hump

• Pt usually present between the age of 10 to 15. F>M

• Deformity is the only symptom• Severity depends on which part of the spine

involved. Higher curves are noticed earlier.• more prominent on flexion unlike postural

curves• The shoulder is elevated on the side of convexity

and the hip sticks out on the side of concavity• Thoracic scoliosis the breasts are asymmetrical

and the rib angles protrude

X-ray:• Should include full length view of the spine• The angle of curvature (cobb’s angle) is

measured• Xray of the pelvis may show Risser’s sign (iliac

apophysis has ossified and fused)- sign of skeletal maturity, progression is minimal afterwards

Treatment

• The aim is to prevent the curve becoming severe and correcting the existing deformities.

• The younger the child andthe higher the curvethe worse the prognosis

• 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

• Conservative treatment Vs. Operative treatment

Conservative treatmentBarcing:• For progressive curves between 20 and 40

degrees• For well balanced double curves• With younger children until they reach

adolescence (iliac apophysis ossified and fused)• Prevent recurrence after spinal fusionMilwaukee brace, more recently Boston brace

Milwaukee brace Boston brace

Operative treatment• Curves that progress more than 40 degrees• 50% correction is regarded satisfactory

Kyphosis

• The term kyphosis is used to describe both the normal gentle rounding of the dorsal spine and the abnormal excessive dorsal curvature - deformity.

Types of kyphosis

Postural kyphosis

It is common (‘round back’ or ‘drooping shoulders’) and may be associated with other postural defects such as flat-feet

Structural kyphosis Is fixed and associated with changes in the shape of the

vertebrae. It may occur inosteoporosis of the spineankylosing spondylitis 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 from: congenital defect fracture

spinal tuberculosis

Kyphos (or Gibbus)

Scheuermann’s disease(adolescent kyphosis)

• This is a developmental disorder of the growing spine in which there is irregular ossification and possibly some fragmentation of the vertebral body epiphyses

• The result is irregularity of mature vertebral end-plates and could be associated with small central herniations of disc material into the vertebral body (schmorl’s nodules)

• Later on when muscle activity increases kyphosis is exaggerated

Scheuermann’s disease(adolescent kyphosis)

2 types: Thoracic scheuermann’s disease Thoracolumbar scheuermann’s disease

Thoracic scheuermann’s disease:More common than the other• Usually appear in mid-thoracic vertebrae• M>F• Teenager, round shouldered, backache, fatigue,

kyphosis which do not improve with change in posture• Treatment: conservative (brace for 18m) or operative

• Lateral radiograph of thoracic spine shows endplate irregularity and vertebral wedging characteristic of Scheuermann's disease

• Thank you