Scoliosis

Question 1

Classification of idiopathic scoliosis (3)

Answer 1

Infantile 0-3years
Juvenile 4-9years
Adolescent 10+ years

Question 2

Infantile idiopathic scoliosis (5)

Answer 2

Left sided curves commonly seen
Boys>girls (3:2)
May resolve spontaneously with growth
Observation is treatment of choice with repeat evaluation every 4-6months
Use of orthoses and surgery not commonly required

Question 3

Infantile idiopathic scoliosis rib vertebra angle difference/rvad (2)

Answer 3

Significant

>20degrees poor prognosis

Question 4

Juvenile idiopathic scoliosis (7)

Answer 4

Onset 4-9years
Male:female ratio approx 1:1
Mostly right thoracic
May rapidly progress especially in children over the age of 5
May require orthotic management
Surgery indicated if curve cannot be controlled by orthotic means
Surgery in a skeletally immature spine brings its own problems

Question 5

Adolescent idiopathic scoliosis (10)

Answer 5

-onset 10+years
-most common type
-mostly right sided
-equal frequency in boys and girls at low curve magnitudes
-girls have sig higher risk of progression (female: male ratio approx 7:1)
-highest risk for curve progression in adolescent idiopathic scoliosis occurs around puberty
(growth spurt)
-pulmonary and cardiac function not impeded with lumbar curves
-significant changes of pulmonary function seen when curve exceeds 70degrees
-pulmonary problems exacerbated by deformity of rib cage
-pulmonary and cardiac function tests may be required pre-operatively

Question 6

King 1 (4)

Answer 6

Lumbar dominant (10%)
S-shaped curve
Both thoracic and lumbar curves cross midline
Lumbar curve larger or more rigid

Question 7

King 2 (4)

Answer 7

Thoracic dominant (33%)
S-shaped curve
Both thoracic and lumbar curves cross midline
Thoracic curve larger or more rigid

Question 8

King 3 (3)

Answer 8

Thoracic (33%)
Thoracic curve
Lumbar curve does not cross midline

Question 9

King 4 (4)

Answer 9

Long thoracic (10%)
Long thoracic curve
L5 over sacrum
L4 tilted into curve

Question 10

King 5 (4)

Answer 10

Double thoracic (10%)
Double thoracic curve
T1 tilted into upper curve
Upper curve structural

Question 11

Presentation of idiopathic scoliosis (5)

Answer 11

Uneven shoulders
Prominent shoulder blade (convex) or breast (concave) 
Uneven waist
Elevated hip
Leaning to one side

Question 12

Decompensated curve (1)

Answer 12

If centre of c7 is not directly above centre of s1

Question 13

Adams forward bending test (1)

Answer 13

Rotational deformity

Question 14

Cervical curve (1)

Answer 14

Apex between c1 and c6

Question 15

Cervicothoracic curve (1)

Answer 15

Apex c7, c7 or t1

Question 16

Thoracic curve (1)

Answer 16

Apex between t2 and t11

Question 17

Thoracolumbar curve (1)

Answer 17

Apex t12 or l1

Question 18

Lumbar curve (1)

Answer 18

Apex l2, l3 or l4

Question 19

Lumbosacral curve (1)

Answer 19

Apex l5 or s1

Question 20

Risser sign (4)

Answer 20

Ossification begins at the asis and progresses posteriorly
Iliac crest is divided into 4 quarters
Stage of maturity designated by the amount of progression
Riser sign 5= skeletal maturity

Question 21

Decompensated curve (1)

Answer 21

If centre of c7 is not directly above centre of s1

Question 22

Adams forward bending test (1)

Answer 22

Rotational deformity

Question 23

Cervical curve (1)

Answer 23

Apex between c1 and c6

Question 24

Cervicothoracic curve (1)

Answer 24

Apex c7, c7 or t1

Question 25

Thoracic curve (1)

Answer 25

Apex between t2 and t11

Question 26

Thoracolumbar curve (1)

Answer 26

Apex t12 or l1

Question 27

Lumbar curve (1)

Answer 27

Apex l2, l3 or l4

Question 28

Lumbosacral curve (1)

Answer 28

Apex l5 or s1

Question 29

Scoliosis bracing contradications (5)

Answer 29

``` Skeletal maturity Severe curve Poor patient cooperation Obesity Thoracic lordosis/hypokyphosis ```

Question 30

Scoliosis orthotic treatment (4)

Answer 30

Milwaukee Boston, cheneau Charleston Spine-cor

Question 31

Milwaukee brace (9)

Answer 31

``` Curve size 20-45 Apex above t8 Growth remaining Moulded pelvic girdle Reduces lordosis Anterior/posterior uprights Neck ring Throat mould Corrective pads/straps ```

Question 32

Boston brace (4)

Answer 32

Moulded prefabricated modular orthosis Reduces lordosis Corrective pads Relief areas for active correctiob

Question 33

Boston brace indications (3)

Answer 33

Apex below t8 Curve size 20-45 Growth remaining

Question 34

Cheneau orthosis (1)

Answer 34

Anterior opening

Question 35

Charleston side-bending brace (7)

Answer 35

Indications/contraindications as for boston brace Night time brace Maximal lateral trunk bending to convexity Apex below t7 Improved compliance?; positive self image Anterior opening Retains muscle strength

Question 36

Spine cor

Answer 36

- non-rigid dynamic brace - discreet under clothing - cooler and less restictive - resuced atrophy

Question 37

Surgery for scoliosis (6)

Answer 37

Posterior approach most common -harrington Instrumentation without fusion 80

Question 38

Harrington instrumentation (3)

Answer 38

Compression rod on convex side Distraction rod on concave side May be done with or without fusion

Question 39

Luque surgery (3)

Answer 39

Posterior approach Segmental wiring No need for postop bracing

Question 40

Anterior approach surgeries (3)

Answer 40

For more severe/rigid -dwyer, zeilke Comvibed approach for curves >80