scoliosis therapy

Question 1

3 characteristics that define scoliosis

Answer 1

1) lateral deviation of spine
2) curvature of >= 10° on radiograph (Cobb’s angle)
3) rotation

Question 2

two origins of spinal deformities and their %

Answer 2

1) congenital: 10%
- failure of segmentation
- failure of formation

2) acquired: 90% (most in adolescent)
Can have multiple causes (syndrome related, post-traumatic, …)

Question 3

when looking at the spine (forward bending test), which is the limit angle when further evaluation is needed?

Answer 3

> = 5°

Question 4

imaging: what is the first step? which machine is preferred and why?

Answer 4

x-ray scan, standing full body (normal impact of gravity), EOS system better to reduce radiation dose

Question 5

adolescent idiopathic scoliosis (AIS): etiology, incidence, which sex is affected more, main cause

Answer 5

• unknown etiology
• 3%, 0.5% > 30°
• more girls
• growth disturbance

Question 6

3 types of risk factors in AIS

Answer 6

1) neuromuscular (lack of evidence)

2) genetic (ex: twins)

3) intrinsic spinal factors: human spinal evolution, forces on spine changed, giving rise to an unstable region (bigger in girls)

Question 7

do endocrine hormones have a role in AIS?

Answer 7

still not clear

Question 8

what determines the direction of idiopathic scoliotic curves?

Answer 8

the rotational pattern in the normal spine

Question 9

give example of neurologic and muscular disorders that cause scoliosis

Answer 9

neurological -> cerebral palsy

muscular:
- duchenne’s muscular dystrophy
- spinal muscular atrophy

Question 10

give examples of syndrome related scolioses

Answer 10

Marfan syndrome
Ehlers-Danlos
Osteogenesis imperfecta
Neurofibromatosis

Question 11

what is the early/conservative treatment? What are the 2 main problems?

Answer 11

Short lumbar brace, or double-shelled brace if angle>20°.
Problem:
- patient compliance
- limitation of transverse corrective load: if angle > 50, traction is needed

Question 12

what are some indications for operative treatment?

Answer 12

• failure of conservative treatment
• increasing pelvic obliquity
• loss of balance
• respiratory distress / eating disorder
• pain

Question 13

treatment of AIS: difference between the goal of conservative and operative treatments

Answer 13

conservative -> avoid progression

operative -> correct and maintain, improvement of cosmesis

Question 14

is the risk of progression worse in younger or older patients?

Answer 14

the younger the patient and the greater the curve, the higher the risk of progression

Question 15

what are the holes in the corrective braces for?

Answer 15

to correct the rotation of the spine

Question 16

which techniques can be used to visualize the deformation better than just x-ray?

Answer 16

3D printing of model
Virtual / augmented reality

Question 17

what are the three steps inside the OR?

Answer 17

registration - navigation - intraop image acquisition

Question 18

what is the definition of early onset scoliosis (EOS)? why is it a big problem?

Answer 18

spine deformity that is present before 10 years of age

If we fuse the spine this early, the thorax and lungs will not be able to grow anymore

Question 19

conservative treatment for EOS: goal, complication rate

Answer 19

• gain time before surgery has to be performed
• 19%

Question 20

operative treatment of EOS: 3 methods

Answer 20

1) distraction based: growing rods -> need for repetitive surgical lengthening

2) compression based

3) guided growth: apex fused, the rest can slide during growth

Question 21

what is the next generation for treatment of EOS?

Answer 21

magnetically controlled growing rods

Question 22

what would the spine bot be used for?

Answer 22

intraoperatively quantify spinal stiffness