Spinal Deformities

Question 1

What is scoliosis?

Answer 1

Sideways curvature of the spine = complex 3D deformity

Question 2

What are some features of scoliosis?

Answer 2

3% prevalence in adolescents, usually mild and pain-free, aetiology unknown, mild hereditary influence, may be due to birth defects/infection/injuries

Question 3

What are the descriptors for scoliosis?

Answer 3

Early onset = infantile (0-3 years) and juvenile (3-10 years)
Adolescent = >10 years

Question 4

What are the two categories of defects that arise in congenital scoliosis?

Answer 4

Defects in formation = wedge vertebrae, hemivertebrae

Defects in segmentation = unilateral bar, unilateral bar and hemivertebrae, block vertebrae

Question 5

What are the two causes of neuromuscular scoliosis?

Answer 5

Neuropathic = cerebral palsy, syringomyelia, spinal tumours, spinal muscular atrophy
Myopathic = Duchenne muscular dystrophy

Question 6

What are some theories of scoliosis aetiology?

Answer 6

Heuter-Volkmann’s Law = increased pressure across epiphyseal growth plate inhibits growth
Triangular spine concept = primary defect is lordotic with secondary bulking
Abnormality of trunk rotation with walking
Neurologic/developmental theories
Specific gene combinations

Question 7

What are some risk factors for scoliosis curve progression?

Answer 7

Cobb angle > 30 degrees
Pubertal growth spurt
Premenarchal girls
Right thoracic curves in girls
Left lumbar curves in boys

Question 8

What are the indications for scoliosis surgery?

Answer 8

High likelihood of curve progression, cosmetically unacceptable, sitting/care in cerebral palsy/spina bifida, breathing difficulties

Question 9

What are the objectives for surgery in scoliosis?

Answer 9

Stop curve progression, obtain maximum correction, improve appearance by balancing trunk, minimise complications

Question 10

What can cause secondary scoliosis?

Answer 10

Neuromuscular causes, tumours, spina bifida

Question 11

What are some non-operative managements for scoliosis?

Answer 11

Serial corrective cast, bracing, corrective exercises, electrical stimulation

Question 12

What should be considered for surgery of deformity?

Answer 12

rate of deterioration, functional level, life expectancy, general condition

Question 13

What are some surgical methods for scoliosis?

Answer 13

One stage posterior surgery, anterior surgery, combined surgery

Question 14

What is way to assess the curve of the spine in scoliosis?

Answer 14

Forward bend test = accentuates curve

Question 15

What is kyphosis?

Answer 15

Forward bend of spine

Question 16

What are some causes of kyphosis?

Answer 16

High pre-load
Centre of gravity anterior to spine
Post infectious (developing countries)
Post traumatic/congenital or degenerative

Question 17

What are some treatments for kyphosis?

Answer 17

Surgery for angle beyond 70 degrees, treatments of limited success, surgery very risky

Question 18

What is spondylolysis?

Answer 18

Stress fracture of isthmus of vertebral arch

Question 19

What may occur when a spondylolysis is healing?

Answer 19

May elongate and cause spondylolisthesis (slipping of vertebra)

Question 20

What is a grade 1 or 2 spondylolisthesis?

Answer 20

Abnormal neighbouring discs, treated with posterolateral stabilisation in-situ

Question 21

How is spondylolisthesis graded?

Answer 21

Using Meyerding grading = 1-4, Grade 5 is spondylolisthesis

Question 22

What is the surgical treatment of spondylosis and spondylolisthesis?

Answer 22

Only when conservative treatment has failed, adolescent with >50% slip, progressive neurological deficit or postural deformity
Treated with L4/S1 fusion or combined surgery

Question 23

How is grade 3+ spondylolisthesis treated?

Answer 23

Combined discogenic and nerve root problem = one stage combined anterior and posterior stabilisation