Scoli (Quiz 3) Flashcards
Idiopathic
relating to or denoting any disease or condition that arises spontaneously or for which the cause is unknown
idiopathic scoliosis
lateral curvature of the spine equal or greater then 10 degrees in the absence of any congenital spinal anomaly or associated musculoskeletal condition
Early/Late Onset Scoliosis
Infantile onset (0-3)
Juvenile (4-10)
When does adolescents end
when great plates fuse (skeletal maturity)
Goals of idiopathic scoli treatment
reduce RVAS; phase rotation
decrease curve magnitude
improve balance
prevent surgery
prevent cardiopulmonary decline
Dr Mehta contributions
Gold standard serial casting protocol
Phase I rotation
apical rib head does not overlap vertebrae
Phase II rotation
apical rib head does overlap apical vertebra
Resolving Curve Progression
RVAD <20 degrees phase I
Progressive Curve Progression
RVAD > 20 degrees phase II
Clinical considerations orthotic management of infantile scoliosis
rapid growth
rip deformation
Orthotic options for Infantile scoli
custom TLSO
lined/framed TLSO
milwuakee
Casting Technique sequence
derotate
gentle stretch
elongate
correct coronal plane deformity
Juvenile Idiopathic Scoliosis
4 years to 10 years
similar to adolescent curve type and orthotic management
AIS Etiology
unknown
theories (biomechanics, nutritional deficiency, structural, endocrine, genetic)
what to look for to determine stage of skeletal growth
risser sign
age
triradiate cartilage
menarche
tanner
Risser Sign
based on location of apophyseal plate
orthotic management best to start at Risser 0
usually weaning out of orthosis around risser 3, 4
What curves are most likely to progress
thoracic and double curves are more likely to progress compare to thoracolumbar or lumbar curves
what is the greatest risk for curve progression
rapid skeletal growth
Treatment of AIS Observations
curve <20 degrees
skeletally mature
exercise
pedicle rotation
rotation goes toward concavity
treatment of AIS orthotic treatment
curves 25-45 degrees
curves 20-25 (with documented progression; gross asymmetry; open triradiates; genetic presdisposition)
AIS Treatment Goals
change natural history further curve progression
avoid surgery
How do we achieve goals
reduce “inbrace” curve magnitude
educate patient/family on proper wearing schedule
targeting the primary adolescent growth spurt
How are critical load (spinal stability) and degree of curvature related?
inversely related
What apex do you suggest a CTLSO
T7 or above
What brace was more effective when controlling thoracic or double curves
Boston Brace
What brace was more effective in controlling lumbar curves
charleston brace
BRAIST Study Results
75% of subjects that wore an orthosis did not require surgery compared to only 42% in the observation group
BRAIST Study Primary Conclusions
orthotic management significantly decreased progression in high risk curves
gains in benefit were seen with increasing hours of brace wear
Biomechanic principles
reduce deforming moment
balance (all three planes)
management of cobb angle
three point pressure system
Greatest influence on patient compliance regarding wearing of the orthosis
difficult paying attention in school
emotional about having to wear orthoses
problems eating
difficulty sitting
Functional Scoliosis
when the patient appears to have a curve in their spine but it is actually caused by another condition
Possible causes of Functional Scoliosis
LLD, muscle spasm, chronic bad posture
