scoliosis Flashcards
what is scoliosis?
lateral deviation of the spine with a cobb angle > 10 degrees
what are the clinical features of scoliosis?
- scoliosis
- shoulder and pelvis assymmetry
- kyphosis
- rib hump (prominence)
- stigmata of spinal dysraphism
- altered neurology - assymmetrical abdominal reflex
how do you perform an adam’s bending test, what does it show?
- patient bends forward at the waist
- looking for rib prominence - rotation
what is the common coronal deformity?
right sided thoracic curve most common
what are the causes of scoliosis?
- idiopathic
- congenital - VACTERL
- neuromuscular - duchene muscular dystrophy and CP
- traumatic
- tumour
- iatrogenic
- syndrome - neurofibromatosis and marfan’s
how does scoliosis present with neurofibromatosis?
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
how does scoliosis present with marfan syndrome?
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
how do you determine sagittal and coronal alignment?
- 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
how do you perform a cobb angle?
cobb angle
the angle between lines drawn parallel to the end plates of the most proximal and distal end vertebrae
which are the end vertebrae?
most tilted vertebrae from the horizontal apical vertebrae
what is the apical vertebrae
vertebrae most deviated from the spinal column
what is the neutral vertebrae?
rotationally neutral vertebrae
what is the stable vertebrae?
most proximal vertebrae most closely bisected by central sacral vertical line
why perform lateral bending xrays?
determines if the scoliosis is flexible
flexible curves normalise with lateral bending but structural curves don’t
which patients should have an mri scan?
- 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
