Adolescent Idiopathic Scoliosis Flashcards
What are the three dimensional torsions involved in scoliosis?
- Lateral curvature in the frontal plane
- Axial rotation in the horizontal plane
- +/- distrubance of the normal curves in the sagittal plane
Two types of curves
- Non-structural curves (postural)
2. Structural curves (fixed)
What are the types of scoliosis?
- Infantile: <2 years
- Juvenile idiopathic: 2-10 years
- Congenital: abnormal vertebrae
- Neuromuscular: e.g. DMD
- Paralytic: SCI
- Adolescent idiopathic (AIS)
Causes of AIS
No specific cause, but most likely multi-factorial with a strong genetic background.
Location of scoliosis
Direction
Apex of the curve
Direction designated by the side of the convexity of the curve
Postural signs of AIS
- Head not centred over body
- One shoulder higher
- One shoulder blade higher and possibly more prominent
- …..
Assessment
Forward bend test
Risser sign
Interprets skeletal maturity and curve progression
Management of AIS
- Bracing
- Surgery
What is bracing used for and when is its use recommended?
Bracing aims to maintain, but not improve scoliosis.
Bracing is recommended for curves >30 degrees in skeletal immature patients.
Different types of bracing for AIS. How long must they be worn for?
- Thoraco-lumbar-sacral orthosis (TLSO)
- Boston brace
Must be worn for 30/24 hours of the day.
Spinal jackets
Aim to maintain a rapidly progressive curve.
Cast changes every 8-12 weeks.
What are the indications for surgical intervention for adolescent idiopathic scoliosis?
- Cosmesis
- Pain
- Neurological compromise
- Risk of respiratory compromise
- Curve progression despite bracing
Aims for surgery
- Correct the curve, but fuse the minimum number of spinal levels
- Ensure spinal balance
- Keep as many lumbar motion segments as possible
- Need to fuse to the stable zones proximally and distally
Surgical complications
- Neurological deficit
- Infection
- Pseudarthrosis at thoracolumbar junction
- Implant failure
- Flat back
- Late hardware removal
- Crankshaft phenomenon
