Scoliosis - Non-structural

Question 1

What is sacral base unleveling?

Answer 1

Curve compensates for the pelvic tilt

Question 2

Most sacral base curves measure less than _____ degrees.

Answer 2

15 degrees

Question 3

What is an anatomic reason for sacral base unleveling?

Answer 3

short leg or short hemi-pelvis

Question 4

What are congenital anomalies for sacral base unleveling?

Answer 4

sacral anomalies and 5th lumbar anomalies

Question 5

What are lower extremity deformities that cause sacral base unleveling?

Answer 5

unilateral pes planus, knee deformities and hip deformities

Question 6

What is unilateral pes planus?

Answer 6

flat feet

Question 7

What are pelvic somatic dysfunctions that cause sacral base unleveling?

Answer 7

superior & inferior innominate shear, anterior & posterior rotation of innominate

Question 8

How short is too short for a leg?

Answer 8

Can be 1/2 inch without symptoms but discrepancies as small as 1/8” can cause symptoms

Question 9

What consequences happen on the long leg side?

Answer 9

arch collapse, osteoarthritis, trochanteric bursitis, premature spinal osteoarthritis, piriformis syndrome

Question 10

What consequences happen on the short leg side?

Answer 10

ovarian cyst, infertility and chronic fetal wastage

Question 11

How would you diagnose a short leg?

Answer 11

asymmetry at the popliteal creases, greater trochanters, gluteal folds, iliac crests, PSIS

Question 12

What happens to the non-structural scoliosis during an Adam’s test?

Answer 12

straightens

Question 13

How would you determine anatomic leg length?

Answer 13

Measure fixed bony landmarks (ASIS and medial malleolus); scanogram, erect AP and Lat lumbar spine and pelvis

Question 14

How would you determine functional leg length?

Answer 14

Measure from midpoint line (umbilicus) to medial malleolus

Question 15

Why is it so important to straighten the spine?

Answer 15

Only have one, joints can be replaced (all other concerns are secondary)

Question 16

If epiphyses are still open what treatment options are available?

Answer 16

Have patient jump on short leg since it stimulates bone growth; if severe staple epiphyses in long leg

Question 17

How often do you reevaluate children? during a growth spurt?

Answer 17

annually; for every inch of increase in height

Question 18

If bone growth is completed what treatment is available?

Answer 18

Heel lift treatment to minimize scoliosis

Question 19

What is the lift equation used to calculate the initial and subsequent incremental increases to the heel lift?

Answer 19

Heilig formula 
Lift = SBD/D+C
SBD - Sacral base declination
D - duration
C - compensation

Question 20

What are the breakdowns for duration?

Answer 20

0-10 = 1
10-30 = 2
Over 30 = 3

Question 21

What are the compensations?

Answer 21

Little or no rotation = 0
Rotation = 1
Early spondylosis = 2
Late spondylosis = 3
Vertebral wedging = 4

Question 22

How do you determine sacral base declination?

Answer 22

Measured by horizontal line across base and placing lines vertically through each hip joint= vertical height difference

Question 23

What is Lloyd/Eimerbank classifications used for?

Answer 23

typing the patterns of pelvic disproportions

Question 24

Describe Lloyd/Eimerbank classifications type I, Ia, Ib

Answer 24

1 - parallel unleveling
1a - femoral head unleveling greater
1B - sacral Base unleveling greater

Question 25

Describe Lloyd/Eimerbank classifications Type II and III

Answer 25

II - no sacral tilt; femoral head unleveling

III - sacral base unleveling only

Question 26

At what point must platforms be added to a shoe?

Answer 26

over 1”