Non-Structural Scoliosis Flashcards
What happens with sacral base unleveling?
Curve compensates for the pelvic tilt. Most curves measure less than 15 degrees, even if the unleveling is severe. This compensatory curve is a frequent cause of low back pain.
What is a common cause of non-structural scoliosis?
Sacral base unleveling
What are the categories of etiologies for sacral base unleveling?
Anatomic
Congenital anomalies
Lower extremity deformities
Pelvic somatic dysfunction
What are the anatomic etiologies of sacral base unleveling?
Short leg & short hemi-pelvis
What are the congenital anomaly etiologies of sacral base unleveling?
Sacral & L5 anomalies
What are the lower extremity deformity etiologies of sacral base unleveling?
Unilateral pes planus, knee deformities, hip deformities
What are the pelvic somatic dysfunction etiologies of sacral base unleveling?
Superior & inferior innominate shear, anterior & posterior rotation of innominate
What defines a short leg?
If the only deformity present is a leg length inequality, then a person can have up to 1/2” short leg life-long, without symptoms. However, in the presence of other problems in the back or pelvis, discrepancies as small as 1/8” can cause the back to become symptomatic.
What are known consequences of a leg length inequality greater than 1/2”?
Arch collapse - long leg side Osteoarthritis - hip on long leg side Trochanteric bursitis - long leg side Premature spinal osteoarthritis Piriformis syndrome - long leg Ovarian cyst - short leg side Infertility/chronic fetal wastage
When diagnosing non-structural scoliosis, where should you look for asymmetry?
Popliteal creases Greater trochanters Gluteal folds Iliac crests PSIS
When assessing the mid-gravity line and Adam test, what should you see?
Mid-gravity line - all the spinous processes should be mid-line
Adam test - curves should straighten
How can you determine leg length?
Measure between fixed bony landmarks
X-Ray: scanogram in growing child or adolescent - look at epiphysis
X-Ray: erect AP & lateral lumbar spine & pelvis
How do you measure the anatomic leg length?
Measure distance from ASIS to medial malleolus
How do you measure the functional leg length?
Measure distance from midline point (umbilicus or xiphoid process) to medial malleolus
What is the goal of treatment for non-structural scoliosis?
Straighten the spine, usually by leveling the sacral base. All other concerns are secondary.
What is treatment if epiphyses are still open in children?
Repetitive compression stimulate bone growth
Have patient jump rope or hop around on short leg only
If inequality is severe - can surgically staple epiphyses closed in the long leg to allow short leg to catch up
How are plates and screws used to halt epiphyseal growth?
Take them out when legs are more even so longer leg can continue to grow alongside shorter leg.
What is the management of children with leg length inequality and scoliosis?
Typically children are reevaluated annually, unless they are in a growth spurt. During rapid growth, the child is reevaluated for every inch of increase in height (can be measured by parents at home).
If bone growth is completed, what treatment can be used?
Heel lift treatment - want to minimize the scoliosis. Must be tailored to the individual. In some patients, an entire lift can be placed at a time. In others, lift may need to be applied in increments as small as 1/16” over months or years to allow body to adapt to the lift.
What is the Heilig formula?
Formula gives the amount of the initial heel lift and the amount of subsequent incremental increases.
Lift = (sacral base declination)/(duration) + (compensation)
How is duration calculated for the Heilig formula?
D = 1 (0-10 years) D = 2 (10-30 years) D = 3 (over 30 years)
How is compensation calculated for the Heilig formula?
C = 0 (little or no rotation) C = 1 (rotation) C = 2 (early spondylosis) C = 3 (late spondylosis) C = 4 (vertebral wedging)
How is sacral base declination measured?
By extending a line horizontally across the sacral base to lines projected vertically through the apex of each hip joint. Vertical height difference between the sides is the sacral base declination.
What is the Lloyd/Eimerbrink classification?
Classification system for patterns of pelvic disproportion: lower line represents femoral heads, upper line represents sacral base plane.
I - parallel unleveling
Ia - disproportion same side; femoral head unleveling greater
Ib - disproportion same side; sacral base unleveling greater
II - no sacral tilt; femoral head unleveling
III - “primary sacral tilt”; sacral base unleveling only
