Spinal Deformity Flashcards
what are the 4 components of scoliosis features?
rotational component
lateral bend component
Rib deformities
Visceral abnormalities
what are the 4 categories of scoliosis?
congenital early onset idiopathic late onset idiopathic secondary - majority are idiopathic of some sort
what are the subtypes of congenital scoliosis?
defect of formation - wedge shaped vertebra - hemivertebra defects of segmentation - unilateral bar (partly fused together) +/- hemivertebra - block vertebra (fused together)
what is a hemivertebra?
unilateral complete failure of formation
what is a wedge vertebra?
unilateral partial failure of formation
single unbalanced growth plate vs multiple (e.g hemivertebra and unsegmented bar)?
single can produce a more balanced deformity whereas multiple will produce a very severe, cosmetically unattractive deformity
what is the Heuter Volkmann’s theory for development of idiopathic scoliosis?
increased pressure across an epiphyseal plate inhibits growth
what is the most likely explanation for idiopathic scoliosis at present?
some sort of sub clinical neurologic asymmetry is the triggering factor
possible combinations of gene expression
describe the latest research into idiopathic scoliosis
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
early vs late onset idiopathic scoliosis presentation?
early onset can often correct itself
late onset - rib asymmetry usually noticed by parent, teacher etc
give 3 examples of things which can cause a secondary scoliosis?
neuromuscular
tumours
spina bifida
how is secondary scoliosis treated?
treat the underlying cause
what are 4 non-operative management options for scoliosis? what are the outcomes like?
serial corrective casts bracing corrective exercises electrical stimulation results variable and often dissapointing
what 4 factors must be taken into account before undertaking surgery in scoliosis?
rate of deterioration
functional level
life expectancy
general condition
is surgery always needed for idiopathic scoliosis?
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
name 4 types of scoliosis surgery
one stage surgery
anterior surgery
posterior
combines surgery
when might combined surgery be needed?
in a complex, fixed deformity
what is kyphosis?
where the centre of gravity lies anterior to the spine
normal in thoracic and sacral regions but can be abnormal
how can abnormal kyphosis occur?
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
how is kyphosis managed?
treatment has limited success
surgical treatment is possible but very risky
what is spondylolysis?
crack/defect in the pas interarticularis of the vertebra
what is spondylolisthesis?
the forward slippage of one vertebra onto another
can co-exist with spondylolysis but is not the same
how is spondylolisthesis graded?
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
what is grade 5 spondylolisthesis also called?
spondyloptosis
in what 4 situations may surgery be used in spondylolisthesis?
if conservative treatment fails
in an adolescent with >50% slippage
progressive neurological deficit
postural deformity
what surgery would be performed for a grade 1/2 spondylolisthesis with abnormal neighbouring discs?
posterolateral stabilisation in situ
- fusion of vertebrae
what surgery would be performed for a grade 3+ spondylolisthesis with combined discogenic and nerve root problem?
one stage combined anterior and posterior stabilisation
