Spinal conditions

Question 1

The Cobb angle

Answer 1

Most common measure of the magnitude of a spinal deformity
Superior vertebral endplate is selected for upper line and the inferior vertebral endplate is used for the lower line
Select the most inclined end plates at curve extremities
Accepted measurement error = 5-7 degrees

Question 2

Non-structural scoliosis (postural)

Answer 2

Flexible curve that corrects on side bending, sitting or lying down
Reversible if primary cause is addressed
Primary causes = postural scoliosis, conversion disorder; pain in LL; back pain; compensatory

Question 3

Structural scoliosis

Answer 3

Segment of spine is curved and is not reversible with any type of treatment or posture change

Question 4

Features of atypical curves

Answer 4

Structural scoliosis in a male
significant pain
thoracic curve convex to LEFT
abnormal findings on neurological exam
rapidly progressing curves
onset in childhood rather than adolescence 
Will need an MRI

Question 5

Scoliosis assessment

Answer 5

Observation - cafe au lait spots, extra long limbs-fingers-toes
Trunk asymmetry - posture, shoulder heights, scapular prominence, waist angles, leg length difference, pelvic symmetry, loss of normal thoracic kyphosis
gait assessment and ambulation status
Neurological examination - sensation, power, reflexes
Adam’s forward bending test - rib hump

Question 6

Scoliosis general management guideliens

Answer 6

10-25 degrees = observe
25-40 degrees - brace, must be skeletally immature - prevents deformity progression
>40 degrees = consider surgical correction and fusion

Question 7

Role of Physio - before surgery

Answer 7

Find out what surgical approach will be used and what levels to be fused
Is chest Wal and therefore pulmonary function being disrupted
Teach respiratory and circulatory care techniques
Practise log rolling and lying - sit techniques
Prepare any equipment required post-op

Question 8

Role of Physio - after surgery - day 0

Answer 8

Respiratory care/supported cough
Circulatory care
Bed mobility techniques, log rolling, sit up in bed

Question 9

Role of Physio - day 1

Answer 9

Stand and march on spot - often use rollator at first
Sit out of bed at least 30 mins of day
Respiratory and circulatory care

Question 10

Role of Physio - day 2 onwards

Answer 10

Respiratory care/supported cough
Circulatory care
Pre-discharge do 6 minute walk test

Question 11

Spondylolisthesis

Answer 11

Loss of sagittal alignment of vertebra
Most common L4-5; L5-S1
Defect in either/both pars interarticularis

Question 12

SDL treatment

Answer 12

Lumbar spine flexion postures relive SPL symptoms
teach abdominal//gluteal muscle activation and posterior pelvic tilt when standing and walking
exercise program should include core stability, postural training, general fitness and weight loss

Question 13

Halo Traction use

Answer 13

Congenital or large deformities may be rigid
Some cases become unstable during growth and compromise neurology
Signs of spinal cord compression
Nerve root compression
Deterioration of bladder/bowel function
Gait disturbances

Question 14

How does the Halo traction help?

Answer 14

Gives some initial deformity correction
Gentle, prolonged lengthening and release of neural, meningeal, ligamentous, disc and spinal cord tissues
Lung function improves
Traction occurs as outpatient - cheaper for family

Question 15

Congenital Scoliosis

Answer 15

Present in-utero
Wide variety of presentations – failure of formation, segmentation, 3D deformity
Progression risk varies – 75% progress
At risk of neuro compromise – cord, nerve root compression – may require Halo traction prior to surgical intervention
At risk of secondary medical issue – deformities impact lungs, GIT growth

Question 16

Congenital Scoliosis management

Answer 16

Conservative management often unsuccessful
Progression can be rapid during growth spurt
Aim to avoid any loss of function or QoL due to surgery