Scoliosis - finished

Question 1

What are the way that scoliosis can be named?

Answer 1

Named by location:
- cervical, cervico-thoracic,

Named by convexity or concavity

Named by aetiology:
C - congenital
I - infection
T - trauma
T - tumour
I - idiopathic
N - neuromuscular

Named by structural or non-structural:

• Structural = idiopathic, congenital, NM, infection
• Non-structural = leg length, IBD, protective spasm

Question 2

What is the apical vertebra?

Answer 2

The most rotated vertebra in the curve, the most deviated vertebrae from the vertical axis of the patient.

Question 3

What is a Gibbus deformity?

Answer 3

A sharply angular kyphosis.

Question 4

What is rib hump?

Answer 4

The prominence of the ribs on the convexity of a spinal curvature, usually due to vertebral rotation, best exhibited on flexion.

Question 5

What % of scoliosis are idiopathic?

Answer 5

80%

Question 6

What scoliosis should we monitor very closely?

Answer 6

Idiopathic scoliosis in those 12-16 males and females but more often females, with a convex left scoliosis.

Question 7

What % of juvenile scoliosis require surgery?

Answer 7

30%

Question 8

What is the mosty common idiopathic scoliosis?

Answer 8

Convex right thoracic scoliosis

Question 9

Why is 12-16 the critical period for scoliosis patients?

Answer 9

Once spinal growth has ceased, as indicated by the fusion of the iliac apophysis, further progression is unlikely.

Question 10

How is congenital scoliosis distinguished?

Answer 10

By presence of anomalies of ribs or vertebrae

Question 11

What are the common anomalies observed in scoliosis?

Answer 11

Hemivertebrae, block vertebrae, spina bifida, bridging vertebral bars, joint deformities, fusion of ribs

Question 12

What does the presence of a lateral wedge deformity of a vertebrae cause?

Answer 12

Result is impaired growth at discovertebral junction on the concave side of the curvature because of excessive compressive forces.

Question 13

What are some Common complications associated with scoliosis?

Answer 13

• Cardiopulmonary: restricted rib cage mvt, restricted lung volume can lead to pulmonary hypertension with subsequent right and left congestive failure.
• Organ compression
• Degenerative: loss of disc heights, osteophytes.
• Fatigue and joint dysfunction syndromes.
• Radiation exposure (in radiographically viewing progression).

Question 14

What are the 4 basic parameters inverstigated in a scoliosis?

Answer 14

1) curvature
2) rotation
3) flexibility
4) skeletal maturation

Question 15

Describe the Cobb Lippman method of scoliosis assessment

Answer 15

A line is drawn along superior border of cephalad (top) vertebrae
+
A line is drawn along inferior of caudad (bottom) vertebrae

If endplates not visible then bottoms and tops of pedicles used.

Perpendicular lines are then drawn from each horizontal line, and the angle of their intersection measured.

Cobb method gives larger measurements then Risser technique by average of 25% or about 10 degrees

Question 16

Describe the Risser-Ferguson method of scoliosis assessment

Answer 16

The centres of the end (top and bottom) and apical vertebral bodies are identified. These points are then connected and the angle of intersection measured.

Question 17

Describe the pedicular rotation method of assessment of a scoliosis

Answer 17

Most accepted method.
Movement of pedicle on convex side of curve is graded between 0 and 4.
Measure of anterior deformity (rotation)
CT the only optimal way to guage exact rotation.

Question 18

Information regarding scoliosis flexibility

Answer 18

Defined as the degree of mobility within a scoliosis.
Can show the correctability of a scoliosis or progression.
Lack of flexibility contraindication to spinal fusion.

Question 19

How is scoliosis flexibility evaluated?

Answer 19

Evaluated primarily by a supine lateral bending radiograph into the convex side of the curve.
Cobb method applied when at end ranges of flexibility.

Question 20

What are the 3 areas of assessing skeletal maturity?

Answer 20

1 - Comparing left hand and wrist to Gruelich and Pyle atlas

2 - Observing the vertebral ring epiphysis

3 - Observing the iliac epiphysis.

Question 21

Left Hand and wrist - maturity (info)

Answer 21

Compared with atlas.

In general, scoliotic females more mature between 11 and 12 and less mature between 15-17 (skeletal maturity).

Interpreted this means that the growth period in scoliotic females is lengthened.

The distal radial epiphysis closes at the same time as the vertebral body epiphysis.

Question 22

Vertebral ring epiphyses - maturity (info)

Answer 22

Normal traction epiphyses at peripheral body margins

Do not contribute to vertical body growth, their fusion to the body rim very closely parallels arrest in spinal growth.

Recognition of the fusion is most accurate indicator of completed spinal growth and can be interpreted as a strong inhibiting factor to future scoliotic progression.

Question 23

Iliac Epiphysis (Risser’s sign) - maturity (info)

Answer 23

Apophysis of iliac appears laterally near A.S.I.S and progresses medially to PSIS (called capping).

Gradual extension graded in quarters: ie 1+ 25%, 2+50% etc.

When epiphysis is fused to ilium graded 5.

Capping for boys occurs at 16, females 14.

Complete excursion from ASIS to PSISI takes approx. 1 yr.
- 2 -3 yrs. for complete osseous union to occur.

Pattern of formation and closure parallels formation and progression of the scoliosis.

In pre-adolescent child (10-15yrs) prior to iliac epiphysis appearance, usual for curve to show greatest rate of progression.

Once epiphysis becomes visible, curve progression slows and eventually ceases when epiphysis fuses.

Question 24

What is the growth period like for females with scoliosis?

Answer 24

They have more skeletal maturity at ages 11-12 but then have slower maturation so by the time they get to 15-17 they are less skeletally mature than non-scoliotic patients.

Question 25

What epiphysis closes at the same time as the distal radius?

Answer 25

The vertebral body epiphysis

Question 26

What ages does pisiform ossify?

Answer 26

10-12 yoa

Question 27

What ages do males and females vertebral ring epiphyses fuse?

Answer 27

Females: 16-20
Males: 18-22

Question 28

At what ages does ‘capping’ occur for males and females?

Answer 28

Females: 14
Males: 16

Question 29

How long does it take for ‘capping’/excursion from ASIS to PSIS to occur?

Answer 29

approx 1 year

Question 30

How long does it take for complete osseous union of the iliac crest to occur?

Answer 30

2-3 years

Question 31

How does iliac crest fusion relate to scoliotic curve development?

Answer 31

In preadolescent children (10-15) prior to iliac epiphysis appearance, usual for scoliotic curve to show greatest rate of progression.