Scoliosis and Spinal deformity Flashcards
what causes the vast majority of scoliosis
idiopathic
describe the deformity in scolisosi
complex- rotational component, lateral bend component, rib deformities, visceral abnormalities
what are the four types of scoliosis
congenital (developmental abnormality)
early onset idiopathic
late onset idiopathic
secondary
what are the 4 commonest subtypes of congenital scoliosis
wedge vertebrae (unilateral partial failure of formation)
unilateral bar (+/- hemivertibrae) (unilateral failure of segmentation)
hemivertebra (unilateral complete failure of formation- can be fully segmented, semisegmented and incarcerated)
block vertebra (bilateral failure of segmentation)
what is the common theme amongst congenital scoliosis
imbalance in the number of growth plates- the greater the imbalance the greater the potential deformity
can early onset idiopathic correct itself
sometimes
what can cause a secondary scoliosis
neuromuscular
tumours
spina bifida
what is the non operative management of scoliosis
serial corrective casts
bracing
corrective exercises
electrical stimulation
(often disappointing results)
what should be taken into account before deciding about surgery
rate of deterioration
functional level
life expectancy
general condition
what surgery can sometimes treat effectively a short segment thoracolumbar scoliosis
anterior surgery (one stage surgery)
what type of deformity might need a combined (anterior and posterior) surgery (as staged procedures)
complex, fixed deformities
name two other deformities of the spine exuding scoliosis
kyphosis
spondylolisthesis
describe a kyphosis deformity
centre of gravity anterior to the spine
high pre load
may be opposite of scoliosis
what is spondylolysis
defect in the pars interarticularis of the vertebra
what is spondylolisthesis
the forward slippage of one vertebra on another
what is meyerding
grading of severity of spondylolisthesis (quarters, grades 1-4, grade 5 is spondyloptosis)
what is spondyloptosis
100% subluxation of a superior vertebral body on an inferior one
when should surgical treatment of spondylolysis/listhesis be considered
when conservative treatment has failed
adolescent with >50% slip
progressive neurological deficit
postural deformity
what is a grade 1 or 2 spondylolisthesis
abnormal neighbouring discs
posterolateral stabilisation in situ
what is a grade 3 spondylolisthesis
combined discogenic + nerve root problem
one stage combined anterior and posterior stabilisation
