Exam 2: Scoliosis Flashcards
Curves less than ___ degrees are just postural changes
10 degrees
If curve is greater than 10 degrees, and is accompanied by vertebral rotation it is called
Scoliosis
___% of cases are idiopathic
80
MC scoliosis
Right thoracic
Functional scoliosis
Caused by postural problem, muscle spasm, or leg-length inequality
Structural scoliosis
Bony distortion
Which type of scoliosis can often be addressed
Functional
Scoliosis affects how many people in US
5-7 million
Scoliosis most often develops between ages
10-15
Boys or girls most commonly affected?
Girls
Can scoliosis be inherited?
Yes, those w/ parents or siblings who have it should be evaluated
Prevalence in kids 10-16 years old
2-4%
Ratio of girls to boys having a curve greater than 30 degrees
10:1
What population of young girls are at highest risk
Scoliosis greater than 25 degrees, but haven’t had 1st menstrual period
Risser grades
1 = 25% 2 = 50% 3 = 75% 4 = 100% 5 = skeletal maturity
Low risk of progression
5-15%
Moderate risk of progression
15-40%
High risk of progression
40-70%
Very high risk of progression=
70-90%
Curve and Risser sign associated with a high risk of progression
20-29 degrees w/ 0/1 Risser sign
> 29 degrees w/ 2-4 Risser sign
Curve and Risser sign associated w/ very high risk of progression
> 29 degrees w/ 0-1 Risser sign
Scoliosis develops in 2 stages
Curve initiation
Curve progression
Hueter-Volkmann Law
Bone growth before skeletal maturity is stunted by mechanical compression on growth plate; and is accelerated by growth plate tension
Treatment options
Careful observation
Bracing
Surgery
Most common treatment option
Careful observation
T/F: most scolioses do not progress and cause few, if any, physical problems
True
Bracing is generally used on kids who
- Have not reached skeletal maturity
2. Curves btw 25-45 degrees
Surgery is used in cases where
Curves are >45 degrees and are progressive
Function of vital organs are affected
Chiropractic interventions
Adjustments
Exercises and EMS
American Academy of Ortho Surgeons recommends screening girls and boys
Girls = 2x (ages 10 and 12)
Boys = 1x (age 13 or 14)
American Academy of Pediatrics recommends screening kids at ages
10, 12, 14, and 16
Adam’s Forward Bend Test
Patient asked to bend 90 degrees at waist
Examiner can view asymmetry of trunk/spinal curvatures
Screening hints
Shoulders different heights Head not centered over pelvis Prominent hip/uneven waist Rib cages diff heights Changes in overlying skin Leaning of body
Cobb angle of ___ degrees defines scoliosis
10
Moderate curves (20-40 degrees) are treated w/
Patient and bracing
MC brace used to treat scoliosis
Boston Brace
Thoraco-lumbar-sacral orthosis (TLSO)
Milwaukee brace
Similar to Boston Brace, but includes neck ring
CTLSO
Braces have ___% success rate at halting curve progression
74%
Bracing does NOT ____ but may ____
Correct scoliosis; may prevent serious progression
Braces usually recommended to be worn ___ hours per day
23 is optimal (but at least 16)
Curves in growing children greater than __ degrees require spinal fusion
40 degrees
Skeletally mature patients can be observed until their curves reach
50 degrees
Thoracic scoliosis surgery results in loss of
Kyphosis (also lumbar lordosis over time)
5-7 years post-surgery 1/5-1/3 of patients experienced
LBP and disc degeneration below fusion
