Spinal Deformities Flashcards
What is scoliosis?
Sideways curvature of the spine = complex 3D deformity
What are some features of scoliosis?
3% prevalence in adolescents, usually mild and pain-free, aetiology unknown, mild hereditary influence, may be due to birth defects/infection/injuries
What are the descriptors for scoliosis?
Early onset = infantile (0-3 years) and juvenile (3-10 years)
Adolescent = >10 years
What are the two categories of defects that arise in congenital scoliosis?
Defects in formation = wedge vertebrae, hemivertebrae
Defects in segmentation = unilateral bar, unilateral bar and hemivertebrae, block vertebrae
What are the two causes of neuromuscular scoliosis?
Neuropathic = cerebral palsy, syringomyelia, spinal tumours, spinal muscular atrophy Myopathic = Duchenne muscular dystrophy
What are some theories of scoliosis aetiology?
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
What are some risk factors for scoliosis curve progression?
Cobb angle > 30 degrees Pubertal growth spurt Premenarchal girls Right thoracic curves in girls Left lumbar curves in boys
What are the indications for scoliosis surgery?
High likelihood of curve progression, cosmetically unacceptable, sitting/care in cerebral palsy/spina bifida, breathing difficulties
What are the objectives for surgery in scoliosis?
Stop curve progression, obtain maximum correction, improve appearance by balancing trunk, minimise complications
What can cause secondary scoliosis?
Neuromuscular causes, tumours, spina bifida
What are some non-operative managements for scoliosis?
Serial corrective cast, bracing, corrective exercises, electrical stimulation
What should be considered for surgery of deformity?
rate of deterioration, functional level, life expectancy, general condition
What are some surgical methods for scoliosis?
One stage posterior surgery, anterior surgery, combined surgery
What is way to assess the curve of the spine in scoliosis?
Forward bend test = accentuates curve
What is kyphosis?
Forward bend of spine
What are some causes of kyphosis?
High pre-load
Centre of gravity anterior to spine
Post infectious (developing countries)
Post traumatic/congenital or degenerative
What are some treatments for kyphosis?
Surgery for angle beyond 70 degrees, treatments of limited success, surgery very risky
What is spondylolysis?
Stress fracture of isthmus of vertebral arch
What may occur when a spondylolysis is healing?
May elongate and cause spondylolisthesis (slipping of vertebra)
What is a grade 1 or 2 spondylolisthesis?
Abnormal neighbouring discs, treated with posterolateral stabilisation in-situ
How is spondylolisthesis graded?
Using Meyerding grading = 1-4, Grade 5 is spondylolisthesis
What is the surgical treatment of spondylosis and spondylolisthesis?
Only when conservative treatment has failed, adolescent with >50% slip, progressive neurological deficit or postural deformity
Treated with L4/S1 fusion or combined surgery
How is grade 3+ spondylolisthesis treated?
Combined discogenic and nerve root problem = one stage combined anterior and posterior stabilisation
