Orthopedics - The Spine (Jurkovic) Flashcards
Deformities are defined by what the plane of the deformities. What defines a Scoliosis? What defines a Kyphosis or Lordosis?
- Scoliosis is defined in the coronal plane by greater than 10 degrees
- Kyphosis or Lordosis is defined by the sagittal plane. Kyphosis is usually 20-40 degree for the thoracic spine, and lordosis increases for the lumbar spine
Where is the curve location dictated by?
based upon apex of the curve
- Cervical C1-C6
- Cervical thoracic C7-T1
- Thoracic T2-T11
- Thoracolumbar T12-L1
- Lumbar L2- L4
- Lumbosacral L5-S1
What are the prominent features of adolescent idiopathic scoiosis (AIS)?
What is its prevalence?
- lateral curvature occuring at or near the onset of puberty without etiology.
- In 2-3% it is <10 degree curve
What two factors are known to predict curve progression?
- Lesser maturity - as you are growing asymmetry can affect the growth of bones
- Larger curve magnitude
How do you measure the Cobb angle?
- Angle created by measuring the a line parallel with the top vertebrae of the top of the curve and another line parelell with the bottom vertebrae of the bottom of the curve.
Why is a double major curve harder to diagnose?
- Because it is there is a compensatory curve for the primary curve thereby making the curve appear not as bad.
Curves under what degree tend not to progress?
What degree curve has the greatest likelihood of progressing?
- Curves under 30 degrees do not tend to progress
- curves greater than 50 degrees
What types of curvatures put patients at an increased risk of cor pulmonale (increased RV due to hypertension in the lungs)
- What degrees does breathing issues result?
What will result in more pulmonary loss?
- patients with a high-angle thoracic curve greater than 100 degrees;
- do not occur until 100-120 degrees
- Lesser curves with significant hypokyphosis (flatter thoracic spine)
What is curvature significance with pregnancy?
- Does not worse during pregnancy and does not cause problems with preg.
What are the manifestations of the rib/vertebral structure in a scoliotic curve?
The ribs are pushed more lateral and anterior on the concave side, the spinous process is deviated to the concave side, the Lamina is thinner and verebral canal is narrower on the convex side. The vertebral body is distorted toward the convex side and the ribs are pushed posteriorly and thoracic cage narrowed on the convex side.
What can neurologic symptoms be indicative of in curvatures?
-progression of the the scolosis.
What is the Adams test?
-Bend forward and look for prominances
What are the big things to look for in a x-ray?
interpedicular widening, congenital abnoramalities, rib pencilling, skeletal maturity
What is the Risser Sign?
It is a # assigned to designate skeletal maturity, the lower the # the more mature and therefore the greater the risk of progression
What are the normal curve patterns?
Lumbar cuve - apex left
Thoracic curve - apex right
What is seen with an Atypical curve?
- Lumbar curve - apex right
- Thoracic curve apex left
- Long C-shaped neuromusclular curve
- Curve with short, sharp apex
What is the criteria for bracing?
A patient with allot of growth left and with a Risser 2 or less and:
- Cobb angle > 25 degrees
- Cobb angle > 20 degrees with documented 5 degrees progression
- *Must have a flexible curve or they will not tolerate the brace
In infantile idopathic scoliosis (birth - 3 yrs) what is used to predict progressive scoliosis?
- Measure the Mehta rib vertebral angle difference (measures sternal to rib angle) and a greater than 20 degree difference between the left and right sides indicates and 80% chance of progression (
For Juvenile Idiopathic Scoliosis (4-10 yrs) what RAD indicates possible progression?
- What else do you need to rule out the absence of an abnormality?
- RAD > 10
- an MRI
