Scoliosis

Question 1

How is the scoliotic curve defined

Answer 1

1. direction of convexity
2. location
3. magnitude via Cobb method

Question 2

What is a compensated scoliotic curve

Answer 2

• 1ºcurve is the major curve
• presence of secondary curves above or below so that shoulders will still be over pelvis

Question 3

What is a decompensated scoliotic curve

Answer 3

• no secondary curves = shoulders are not over pelvis

Question 4

What is a non-structural scolitic curve

Answer 4

• reversible and without rotation
• IE a true leg length causing scolitic curve

Question 5

What is a structural curve

Answer 5

• irreversible
• with rotation
• as the thoracic spine side bends you get some rotation

Question 6

What are the types of structural Scoliotic curves

Answer 6

• idiopathic = 85%
• osteopathic: altered bone structure
• neuropathic: hypertonicity on one side (such as in CP)
• Myopathic: muscle imbalance/altered muscle control

Question 7

Incidence of Adolescent idiopathic scoliosis

Answer 7

• 70-80% of all scolioses
• early onset (EOS) = < 10 years old
• Late onset (LOS) = > 10 y/o
• 2-3% of adolescent popultation (10% require intervention and 0.1% require surgery)
• Gender bias 7:1 female to male

Question 8

Evaluation of scoliosis

Answer 8

• posture assessment
• adams forward flexion: look posterior as they flex forward
• looking for a rib hump
• X-ray

Question 9

Risser Sign

Answer 9

• skeletal maturity
• ossification of iliac crest
• scale 0-5 5= skeletal maturity
• ASIS to PSIS (anterior to posterior)
• 0, 1, 2 highest risk of curve progression

Question 10

Treatment for scoliosis

for skeletally immature < 25º

Answer 10

• monitor
• exercises to stretch and strengthen

Question 11

Treatment for scoliosis

Skeletally immature 25º- 40º

Answer 11

• Bracing
• tria-c, Spinecore
• must be worn for at least 13 hours

Question 12

Treatment for scoliosis

skeletally immature >50º

Answer 12

• instrumented stabilization
• posterior spinal fusion with instrumentation and bone graft
• new techniques video assisted thoracoscpoic spinal fusion

Question 13

What is

Fusionless: vertebral body tethering

Answer 13

• Goes to the side of convexity
• not fusing segments
• rather tethering it together
• develop a more normal stress evenly on vertebral bodies so you dont get the wedging

Question 14

Goals for Treatment

for scoliosis

Answer 14

• prevent progression (correction bonus
• mostly just hold the progression
• minimize the wedging effect due to asymmetrical loading*

• due to wolfs law there are asymmetrical forcces being put onto the bone

Question 15

Exercise interventions for scoliosis

efficacy

Answer 15

• efficacy of exercise to halt scoliotic curvature progression remains debatable
• efficacy of exercise intervention appears related to specificity of the exercise meaning more specific= more effective

Question 16

Scoliosis therapy methods

Answer 16

Schroth

• method has been shown to significantly reduce angle of trunk rotation

Scientific exercise approach to scoliosis (SEAS)

• corrective exercises in three planes
• develop spinal stability and muscle balance
• incorpate breathing exercises
• emphasize posture awareness

both improve the qualty of life