Scoliosis Flashcards
Primary: located on the Thoracic & Sacral area aka____
KYPHOSIS
Secondary: located on the cervical & Lumbar area aka___
LORDOSIS
defined as a lateral curvature in the spine. It usually involves thoracic and lumbar regions.
Scoliosis
Scoliosis is the lateral curvature of the spine greater than or equal to ______, of unknown etiology
10° Cobb with rotation
Cobbs - coronal plane
rotation- transverse plane
What can be the result of Three-dimensional torsional deformity of spine and trunk
+Lateral curvature in the frontal plane
○ Axial rotation in the horizontal plane
○ Disturbance of the sagittal plane normal curvatures, kyphosis and lordosis, usually, but not always, reducing them in direction of a flat back
presenting from birth through age 21
0-2
Infantile scoliosis
presenting from age 3 through age 9+11
3-9
Juvenile scoliosis
presenting from age 10 through age 17+11
10-17
Adolescent scoliosis
presenting from age 18 & beyond
18+
Adult scoliosis
absence of idiopathic curvature associated with degenerative changes and collapse of sagittal and coronal balance;
de novo Scoliosis
more debilitating d/t bone development will also cause progression of abn curvature of spine)
de novo Scoliosis
most common form of scoliosis!
Adolescent idiopathic scoliosis (AIS)
spine deformity that is present before 10 years of age
Early Onset Scoliosis (EOS)
Cobb deg: up to 20
low
Cobb deg: Moderate
21-35
Cobb deg: 36-40
moderate to severe
Cobb deg: severe
41-50
Cobb deg: 51-55
severe to very severe
postural or functional scoliosis since there is no bony deformity!
Nonstructural
Not progressive and reversible type of scoliosis
Nonstructural
type of scoliosis which is Easily correctable once the cause is determined (treatment and rehab procedures can be done)
Nonstructural
type of scoliosis which is caused by muscle guarding or spasm from a painful stimuli in the back or neck, and habitual or asymmetrical postures, hysteria, nerve root irritation, inflammation, or compensation caused by leg length discrepancy or contracture (in the lumbar spine)
Nonstructural
type of scoliosis which shows segmental limitation, and side bending is usually symmetrical
Nonstructural
type of scoliosis which disappears on forward flexion
Nonstructural
type of scoliosis which usually found in the cervical, lumbar, or thoracolumbar area ○ can be changed with forward or side bending and with positional changes, such as lying supine, realignment of the pelvis by correction of a leg-length discrepancy, or with muscle contractions
Nonstructural
type of scoliosis which
Structural
type of scoliosis which
Structural
type of scoliosis which
Structural
type of scoliosis which
Structural
type of scoliosis which primarily involves bony deformity
Structural
type of scoliosis which often progressive and irreversible
Structural
type of scoliosis which is Genetic, idiopathic or congenital
Structural
type of scoliosis which is Structural change in bone & normal flexibility of spine is lost
Structural
type of scoliosis which is Rotation of the vertebral bodies is toward the convexity of the curve
Structural
type of scoliosis which caused by neuromuscular diseases or disorders (e.g., cerebral palsy, spinal cord injury, progressive neurological or muscular diseases), osteopathic disorders (e.g., hemivertebra, osteomalacia, rickets, fracture), and idiopathic disorders
Structural
type of scoliosis which is patient lacks normal flexibility, and side bending becomes asymmetrical
Structural
type of scoliosis which is curve does not disappear on forward flexion and a posterior rib hump is detected
Structural
type of scoliosis which is most commonly seen in the thoracic or thoracolumbar spine = ribs rotate with the vertebrae, so there is prominence of the ribs posteriorly on the side of the spinal convexity and prominence anteriorly on the side of the concavity.
Structural
type of scoliosis which is 75% to 85% of all cases of structural scoliosis
Idiopathic scoliosis
type of scoliosis which vertebral bodies rotate into the convexity of the curve with the spinous processes going toward the concavity of the curve
Idiopathic scoliosis
type of scoliosis which disc spaces are narrowed on the concave side and widened on the convex side
Idiopathic scoliosis
pattern of scoliosis which deviation is in the right
DEXTRO scoliosis
pattern of scoliosis which deviation is in the left
LEVO scoliosis
MC scoliotic curve:
DEXTROTHORACIC Scoliosis (85-90% of AIS)
result of double major curve type of scoliosis
C-curve or S-curve:
largest abnormal curves in the spine and the first to development; readily observable
Major or primary curves
considered to develop after major curve or compensation for major curve to maintain balance
Minor or secondary curves
fixed rotational prominence on the convex side, which is best seen on forward flexion from the skyline view
Razorback Deformity
Thoracic scoliosis results in a very poor cosmetic appearance or greater visual defect
Razorback Deformity
Deformation of the ribs along with the spine
Razorback Deformity
Vary from a mild rib hump to a severe rotation of the vertebrae
Razorback Deformity
Based on the extent of development of secondary sexual characteristics that Determines the progression of the scoliosis
Tanner Staging
Tanner stages Stage 1:
prepubertal
Tanner stages Stage 2:
enlargement
Tanner stages Stage 3:
further enlargement
Tanner stages Stage 5:
Mature stage
Critical Threshold in cobbs angle
30° to 50° Cobb’s angle
what happens in critical threshold
Higher risk of health problems in adult life
Worst case scenario: compression and malposition of the organs within the rib cage = difficulty in breathing esp pag mas malaki yung Cobb’s angle since may compression of structures thus leading to dec rib expansion pag humihinga!
Bone growth in the period of skeletal immaturity is retarded by mechanical compression on the growth plate and accelerated by growth plate tension.
Hueter Volkmann’s Law
Postural Ax for scoliosis
Plumb line test
what is Plumb line test
confirmatory test and para malaman yung severity (yung thread ididikit mo sa spine and since straight yung thread you will look for asymmetries of the spine);
findings in plumb line test
Asymmetric shoulder level.
Rib hump/bump in structural scoliosis
Protrusion of hip on one side
Pelvic obliquity
Inc lumbar lordosis
Uneven waist crease.
What is the normal pelvic angle:
30°.
Radiographic eval: measures degree of angulation
Cobb’s Angle
Radiographic eval: measures degree of rotation
Nash-Moe Grading
Radiographic eval: skeletal maturity
Risser Staging
Radiographic eval: a triad classification system that consists of curve type, lumbar spine modifier and sagittal thoracic modifier (orthopedic surgeons need to know this)
Lenke Classification
What is the skin for scoliosis assessment?
+presence of café-au-lait spots
(neurofibromatosis);
+faun’s beard (spinal
dysraphism)
To detect structural or functional scoliosis
ADAM’S FORWARD BENDING TEST
● Ask the patient to bend forward and reach
for the toes and look for asymmetry!
● Ask the patient to flex forward at the hips
with the fingertips of both hands together
so that the arms drop vertically. The feet
should be together, and both knees should
be straight. Any alteration from this posture
will cause the spine to rotate, giving a false
view.
ADAM’S FORWARD BENDING TEST
Upon forward bending if rib hump in adams forward bending test
○ (+) = STRUCTURAL
○ (-) = FUNCTIONAL
What to note for adams forward bending test
○ asymmetry of the rib cage
○ asymmetry in the spinal
musculature
○ Presence of pathological kyphosis
○ Whether lumbar spine straightens or flexes as it normally should
○ Whether there is any restriction to forward bending, such as spondylolisthesis or tight hamstrings
Test that is usually done c radiographic findings
LATERAL BENDING TEST
The result of LATERAL BENDING TEST when it Does not disappear on lateral bending
structural scoliosis
The result of LATERAL BENDING TEST when Cobb’s of 25° or more on ipsilateral side-bending
radiographic views
STRUCTURAL Scoliosis
Objective measure of spinal curve & rotation
SCOLIOMETER
degree of scoliosis where the risk of progression in
adulthood increases, as well as the risk of health
problems and reduction of quality of life.”
Over 30°
degree of scoliosis where , there is a consensus that it is almost certain that scoliosis is going to progress in adulthood and cause health problems and reduction of quality of life.
Over 50°
increase in the
magnitude of the deformity by more than 5° at
consecutive follow-up appointments of between 4 &
6 months.
Curve progression
tx based on cobb angle and deg of progression: Observation = <20
Observation
tx based on cobb angle and deg of progression: Observation = 20-40
Bracing
tx based on cobb angle and deg of progression: Observation = >40
Surgery
tx based on cobb angle and deg of progression: Observation = 40-50 deg
pain + DJD
tx based on cobb angle and deg of progression: Observation = >60 deg
cardiopulmonary changes and life expectancy
wearing a brace mainly in bed (8-12hr/day)
Nighttime Rigid Bracing
wearing a rigid brace mainly
outside school and in bed (12–20 h per day)
Part Time Rigid Bracing
wearing a rigid brace
all the time (at school, at home, in bed,
etc.)
Full Time Rigid Bracing
Indication for bracing
cobb angle = at least 25
degrees & skeletal immaturity
cobb angle = less than 25
degrees but rapidly progressed
Surgery indication
curves exceeding 45 or 50 deg
Brace for Above t6
milwaukee
Brace for Below t6
miami
Brace for Below t8
boston, wilmington,
yamamoto
TECHNIQUES TO INCREASE LATERAL
FLEXIBILITY OF THE SPINE: lie prone, stabilize
pelvis, reach toward knee with arm on concave
side and contralateral arm reach forward;
parang pinapaflex mo lang si pt
For thoracic curves
stabilize the thoracic
curve by holding on to the edge of the table for
mobilization to be on lumbar spine, examiner
craddles legs and lateral bend away from
concavity
TECHNIQUES TO INCREASE LATERAL
FLEXIBILITY OF THE SPINE: For lumbar curves
heel sitting with
abdomen resting on ant thighs, flex both ue
forward, then have pt lateral bend away from
concave side, hold for 30 secs, 5 reps
TECHNIQUES TO INCREASE LATERAL
FLEXIBILITY OF THE SPINE: For thoracic scoliosis
