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spine > scoliosis > Flashcards

scoliosis Flashcards

1
Q

what is scoliosis?

A

lateral deviation of the spine with a cobb angle > 10 degrees

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2
Q

what are the clinical features of scoliosis?

A
  • scoliosis
  • shoulder and pelvis assymmetry
  • kyphosis
  • rib hump (prominence)
  • stigmata of spinal dysraphism
  • altered neurology - assymmetrical abdominal reflex
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3
Q

how do you perform an adam’s bending test, what does it show?

A
  • patient bends forward at the waist
  • looking for rib prominence - rotation
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4
Q

what is the common coronal deformity?

A

right sided thoracic curve most common

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5
Q

what are the causes of scoliosis?

A
  • idiopathic
  • congenital - VACTERL
  • neuromuscular - duchene muscular dystrophy and CP
  • traumatic
  • tumour
  • iatrogenic
  • syndrome - neurofibromatosis and marfan’s
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6
Q

how does scoliosis present with neurofibromatosis?

A

autosomal dominant disorder due to a defect of the NF1 gene coding the neurofibromin gene

  • scoliosis due to NF1
  • non-dystrophic - long curve
  • dystrophic - short sharp curve - thorolumbar

xray findings:
scalloped vertebrae
rib pencilling

MRI findings:
ductal ectasia
dumbbell lesion - neurofibroma on nerve root

treatment
non-dystrophic
- treat like idiopathic

Dystrophic
- no bracing
- PSF alone - pseudoarthrosis
- ASF and PSF - lower rate of pseudoarthrosis

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7
Q

how does scoliosis present with marfan syndrome?

A

marfans congenital connective tissue disorder
* mutation in fibrillin 1
* meningocele
* ductal ectasia
* arachnodactyl
* long arms - arm span greater than height
* pes planus
* ligamentous laxity
* thumb sign and wrist sign

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8
Q

how do you determine sagittal and coronal alignment?

A
  • coronal balance is determined by alignment of C7 plumb line to central sacral vertical line
  • sagittal balance is based on C7 plumb from center of C7 to the posterior-superior corner of S1
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9
Q

how do you perform a cobb angle?

A

cobb angle
the angle between lines drawn parallel to the end plates of the most proximal and distal end vertebrae

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10
Q

which are the end vertebrae?

A

most tilted vertebrae from the horizontal apical vertebrae

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11
Q

what is the apical vertebrae

A

vertebrae most deviated from the spinal column

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12
Q

what is the neutral vertebrae?

A

rotationally neutral vertebrae

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13
Q

what is the stable vertebrae?

A

most proximal vertebrae most closely bisected by central sacral vertical line

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14
Q

why perform lateral bending xrays?

A

determines if the scoliosis is flexible

flexible curves normalise with lateral bending but structural curves don’t

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15
Q

which patients should have an mri scan?

A
  • syndromic, neuromuscular or congenital scoliosis
  • neurology
  • abnormal abdominal reflexes - syrinx
  • left sided curve
  • acute angular curve
  • significant kyphosis
  • foot deformities associated with scoliosis - cavovarus deformity
  • rapid progression
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16
Q

what are the treatment options for scoliosis?

A
  • <25 degree - observe
  • 25-45 degree - brace
  • > 45 degree - posterior fusion
  • > 75 degree, stiff curves or risser 0 - anterior/ posterior fusion
17
Q

what are the findings of the brace trial?

A

weinstein 2013
- brace worn for a minimum of 13hrs associated with 90% prevention of curve progression

18
Q

why is correction for congenital scoliosis not performed under hypotensive anaesthesia?

A

Risk of ischaemia to the cord is higher due to the variable blood supply in syndromes

19
Q

tell me about bracing for spinal surgery?

A
  • recommended to be worn for >16hrs
  • minimum of 12hrs needed to slow progression
  • curves below T7 - TLSO brace
  • curves above T7 - Milwaukee brace (cervicothoracolumbosacral orthosis)
20
Q

why perform the sitting bending test?

A

this is to determine if the spine deformity is compensatory for LLD

21
Q

tell me about bracing

A
  • recommended for >16hrs
  • minimum of 12hrs to slow progression
  • to slow progression not to correct
  • below T7 - TLSO
  • above T7 - milwauke - cervicothoracic brace

Failure/ success?
- success = <5 degree progression
- failure = > 6 degree progression or progression to >45degrees

22
Q

risk of progression

A

Curve type
* thoracic curves
* double curves

Age remaining
* peak growth velocity - before risser 1 and just before menarche
* curve > 30 deg before peak growth velocity likely to need surgery

Curve magnitude
* >25degree - before skeletal maturity
* >50 deg thoracic and >40 deg lumbar curve - after skeletal maturity - 1-2deg per year

23
Q

risks of surgery for scoliosis

A
  • flat back syndrome
  • superior mesenteric artery syndrome
  • crankshaft phenomen
  • neurological injury - 1:1000
  • infection
  • pseudoarthrosis

spine (12 decks)

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