Lumbar IV/ Group Curves Flashcards
Idiopathic scoliosis diagnosis
. Diagnosis of exclusion
. Classified based on age patient was at time of diagnosis (infantile, juvenile, adolescent if over 10 y/o, adult over 18 y/o)
In function scoliosis, spinal curvature ____ in response to side bending
Straightens
Causes of structural scoliosis
. Congenital . Infectious diseases . Trauma . Neurologic or muscular disorders . Tumors . Leg length inequality . Metabolic (rickets, osteoporosis, RA) . Plagiocephaly (sleeping posture/cranial somatic dysfunction) . Pain
Congenital/genetic effects of scoliosis
. Hereditary . Vertebral anomalies . Marfan’s (dec. GAG and collagen in discs) . Turner’s . Aicardi syndrome . Friedreich ataxia . Schonberg disease . RA . Cushing . Osteogenesis imperfecta
Infectious diseases causing scoliosis
. Polio
. TB
. Osteomyelitis
Neurologic or muscular disorders causing scoliosis
. Cerebral palsy . TBI . Polio . Myelomeningocele . Spinal muscle dystrophy . Spinal cord injury/tumor . Spina bifida . Tethered cord syndrome . Arnold Chiari syrinx
Risk factors for scoliosis
. RA . Muscular dystrophy . Polio . Cerebral palsy . Organ transplants . Female
Prevalence of adolescent idiopathic scoliosis btw 8-14 y/o
1-3%
Prevalence of adult idiopathic scoliosis 25 and above, and then ages 60-90
. 8% over 25 y/o
. 60% in 60-90 y/o
What is progression of scoliosis?
. Inc. in magnitude of Cobb angle over 5 degrees btw successive films
. Average is 2.3 degrees per year
T/F infantile scoliosis can spontaneously resolve, juvenile is progressive, and adult is persistent or worsens
T
Who has the greatest risk of scoliosis progression
. Girls with large curves prior to onset of menstruation
. Curvature happens equally in boys, but progresses more in females
Percentage of idiopathic curves diagnosed in infancy resolves?
50-90%
Do adults or children have a lot of variation in their spinal curve angle day to day?
Children change btw 10-20 degrees
. Adults have little variation
Causes of adult scoliosis
. Progression of childhood scoliosis
. Degenerative lumbar scoliosis: in patients over 50 due to disc degeneration
Untreated idiopathic scoliosis inc. mortality by wha tpercentage?
10%
Percentage of idiopathic scoliosis untreated patients that have cardiopulmonary complications
14%
T/F painful scoliosis is not idiopathic
T
T/F pain is correlated w/ degree of curvature
F
Pulmonary function with scoliosis
. Related to magnitude of Cobb angle
. Higher up the curvature occurs, the more likely problems w/ breathing occur
. Cob. Angle over 100 degree, vital capacity reduced to less than 50% of normal
. 25-50 degree spinal curvature, vital capacity dec. to 70% of normal
. Hypoxemia during sleep
. Pulmonary hypertension
. R ventricular strain measured by EKG causing enlargement
. Rapid/shallow breathing
Hallmark of idiopathic scoliosis diagnosis
Absence of pain
Cobb angle
. Measured on x-ray . Ruler across top/bottom edges of involved vertebrae and lines drawn . Curves named for convexity . Rotoscoliosis is R convexity . Levoscoliosis is L convexity . Measures lat. or AP curves
Normal angles of kyphosis and lordosis
. K: 20-50 degrees
. L: 25-60 degrees
Limitations of Cobb Method
. Reliability and reproducibility
. Can’t accurately measure rotational motion
Adam’s forward bending test is what percent sensitive for curves less than 10 and what percent for curves over 20 degrees?
. Less than 10: 70%
. Over 20: 90%
Adam’s forward bending tests misses ___ percentage of scoliosis curves
. 15%
. Misses all lumbar curves
Angle of trunk rotation (ATR)
. Rib hump during forward bending test
. Signifies vertebral rotation not humping
. Related to Cob angle
. Spinal curvature of 20 degree has ATR of 5 degrees
. Measured using scoliometer
US preventative services task force scoliosis recommendation
. Routine screening for adolescent scoliosis not recommended
T/F DOs should screen all initial patients for scoliosis no matter the age
T
Children should be sent to orthopedics if curve is over ___
. 30 degrees
Children with curves btw 20-30 degrees should be screened ___
Every 6 months
T/F thoracic curves more likely to progress than thoracolumbar curves
T
Patients with curve of 25 degrees or more who have progressed by ____ while being monitored may require treatment?
10 degrees
Mid thoracic general curves classification
. 90% convex R
. 6 vertebra
. Apex T8-9
Lower thoracic/thoracolumbar general curve classification
. Convex R
. 6-8 vertebra
. Apex T11-12
Lumbar spine general classification of curve
. 70% convex R
. 5 vertebra
. Apex L1-2
Double major curves general classification
. 90% convex right thoracic, convex left lumbar
. 5 thoracic, 5 lumbar
. Thoracic apex T7, lumbar apex L2
Scoliosis angle degree classification
. Mild: 10-24 degrees
. Moderate: 25-50 degree
. Severe: over 50 degrees
