Spinal Deformity

Question 1

what are the 4 components of scoliosis features?

Answer 1

rotational component
lateral bend component
Rib deformities
Visceral abnormalities

Question 2

what are the 4 categories of scoliosis?

Answer 2

congenital
early onset idiopathic
late onset idiopathic
secondary
- majority are idiopathic of some sort

Question 3

what are the subtypes of congenital scoliosis?

Answer 3

defect of formation
- wedge shaped vertebra
- hemivertebra
defects of segmentation
- unilateral bar (partly fused together) +/- hemivertebra
- block vertebra (fused together)

Question 4

what is a hemivertebra?

Answer 4

unilateral complete failure of formation

Question 5

what is a wedge vertebra?

Answer 5

unilateral partial failure of formation

Question 6

single unbalanced growth plate vs multiple (e.g hemivertebra and unsegmented bar)?

Answer 6

single can produce a more balanced deformity whereas multiple will produce a very severe, cosmetically unattractive deformity

Question 7

what is the Heuter Volkmann’s theory for development of idiopathic scoliosis?

Answer 7

increased pressure across an epiphyseal plate inhibits growth

Question 8

what is the most likely explanation for idiopathic scoliosis at present?

Answer 8

some sort of sub clinical neurologic asymmetry is the triggering factor
possible combinations of gene expression

Question 9

describe the latest research into idiopathic scoliosis

Answer 9

genetic defect in melatonin receptors leads to hyperexcitability of motor cortex
osteopontin may the inhibiting factor, therefore osteopontin specific antibody may possibly be able to prevent/cure/halt progress

Question 10

early vs late onset idiopathic scoliosis presentation?

Answer 10

early onset can often correct itself

late onset - rib asymmetry usually noticed by parent, teacher etc

Question 11

give 3 examples of things which can cause a secondary scoliosis?

Answer 11

neuromuscular
tumours
spina bifida

Question 12

how is secondary scoliosis treated?

Answer 12

treat the underlying cause

Question 13

what are 4 non-operative management options for scoliosis? what are the outcomes like?

Answer 13

serial corrective casts
bracing
corrective exercises
electrical stimulation
results variable and often dissapointing

Question 14

what 4 factors must be taken into account before undertaking surgery in scoliosis?

Answer 14

rate of deterioration
functional level
life expectancy
general condition

Question 15

is surgery always needed for idiopathic scoliosis?

Answer 15

no
usually just for cosmetic purposes so patient must have no other influencing factors and be sure that the deformity is bad enough to make it worth the risk

Question 16

name 4 types of scoliosis surgery

Answer 16

one stage surgery
anterior surgery
posterior
combines surgery

Question 17

when might combined surgery be needed?

Answer 17

in a complex, fixed deformity

Question 18

what is kyphosis?

Answer 18

where the centre of gravity lies anterior to the spine

normal in thoracic and sacral regions but can be abnormal

Question 19

how can abnormal kyphosis occur?

Answer 19

if something happens to unbalance the erector spinae muscles which hold up the spine - the spine has a tendency to go into kyphosis due to high pre-load

Question 20

how is kyphosis managed?

Answer 20

treatment has limited success

surgical treatment is possible but very risky

Question 21

what is spondylolysis?

Answer 21

crack/defect in the pas interarticularis of the vertebra

Question 22

what is spondylolisthesis?

Answer 22

the forward slippage of one vertebra onto another

can co-exist with spondylolysis but is not the same

Question 23

how is spondylolisthesis graded?

Answer 23

meyerding classification

• grade 1 = 0-25% slippage
• grade 2 - 25-50% slippage
• grade 3 = 50-75% slippage
• grade 4 = 75-99% slippage
• grade 5 = 11% slippage where the vertebra has completely separated from the one below

Question 24

what is grade 5 spondylolisthesis also called?

Answer 24

spondyloptosis

Question 25

in what 4 situations may surgery be used in spondylolisthesis?

Answer 25

if conservative treatment fails
in an adolescent with >50% slippage
progressive neurological deficit
postural deformity

Question 26

what surgery would be performed for a grade 1/2 spondylolisthesis with abnormal neighbouring discs?

Answer 26

posterolateral stabilisation in situ

- fusion of vertebrae

Question 27

what surgery would be performed for a grade 3+ spondylolisthesis with combined discogenic and nerve root problem?

Answer 27

one stage combined anterior and posterior stabilisation