Spine Flashcards
What is the threshold measurement for school screening of pediatric scoliosis before referral?
7 degrees on scoliometer using Adams forward bend test. Correlates best with a 20 degree coronal curve
What is the Risser sign, or grading system?
Ossificatin of the iliac crest apopysis. Graded 0-5. % is complete ossification
Initial evaluation of the spine for scoliosis should include what?
- PA/Lateral radiographs with measurement of Cobb’s angle and Risser sign - Assess trunk balance - Look for congenital abnormalities - Classify scoliotic curve by type
What should be done if apical hypokyphosis is absent in someone with idiopathic adolescent scoliosis?
Get an MRI. It should be present
What is the stable vertebrae?
The most prox vertebrae that is mostly bisected by the center sacral vertebral line
What is the end vertebrae?
The most tilted vertebra
What is the neutral vertebra?
The verebra that has no rotation in the axial plane
What are structural curves in relation to scoliosis?
- It is the largest curve 2. Additional curves that fail to bend <25 degrees
What ‘Risser sign’ has been shown to correlate with the greatest velocity of skeletal linear growth?
Risser 0 covers the first 2/3rd of the pubertal growth spurt and correlates with the greatest velocity of skeletal linear growth.
What are the Risser Stages?
Risser I: is given when the ilium calcification measures 25%. As this stage the velocity of linear skeletal growth is on a descending slope.
Risser II: the greater trochanteric apophysis unites with the femur and Ilium calcification measures 50%. There is usually 3 cm of sitting growth remaining and no further growth in the lower extremities.
Risser III: Ilium calcification measures 75%. There is usually 2 cm of sitting growth remaining.
Risser IV: Ilium calcification is almost complete. There is usually 1 cm of sitting growth remaining.
Risser V marks complete skeletal maturation.
What is the purpose of bracing in adolsescent idiopathic scoliosis?
To halt or slow curve progression. NOT to reverse magnitude of the deformity. Only useful in skeletally immature Pts; Risser stages 0-2
What are indications for bracing in adolescent idiopathic scoliosis?
In skeletally immature pts (Risser 0-2) curves <25degrees can be observed. 25-45 degree flexible curves should be treated with full time bracing
What indicates success in bracing for adolescent idiopathic scoliosis?
Bracing success is most commonly defined as <5° curve progression and failure is 6° or more curve progression at orthotic discontinuation (skeletal maturity), absolute progression to >45° either before or at skeletal maturity, or discontinuation in favor of surgery.
How is skeletal maturity defined?
Skeletal maturity is defined Risser sign 4, <1cm change in height over 2 visits 6 months apart, 2 years postmenarcha
What are the indications for use of TLSO bracing in treatment of adolescent idiopathic scoliosis?
In adolescent idiopathic scoliosis for curves of 25-40deg, apex below T7, in skeletally immature (Risser 0,1,2) patients. This is best seen in Fig E.
Curves <25deg are best treated with observation, and those >40deg do not respond favorably to bracing.
What are some red flags when examining a pt with scoliosis that my cause you to order an MRI?
Typical indications for MRI include patients with a left thoracic curve, abnormal reflexes, rapid curve progression, neurologic symptoms, excessive kyphosis and foot abnormalities.
What is the C7 plumb line and its relation to sagittal balance?
It is a line drawn from the center of the body of C7 to the posterosuperior aspect of S1 body on a lateral radiograph or saggital MRI/CT.
With “neutral” sagittal balance, the C7 plumb line will directly intersect the posterior-superior corner of S1. Positive or negative sagittal balance is described when plumb line is anterior and posterior to this sacral landmark, respectively
