Scoliosis Flashcards by Margaux Nuñez

Primary: located on the Thoracic & Sacral area aka____

KYPHOSIS

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Secondary: located on the cervical & Lumbar area aka___

LORDOSIS

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defined as a lateral curvature in the spine. It usually involves thoracic and lumbar regions.

Scoliosis

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Scoliosis is the lateral curvature of the spine greater than or equal to ______, of unknown etiology

10° Cobb with rotation

Cobbs - coronal plane
rotation- transverse plane

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What can be the result of Three-dimensional torsional deformity of spine and trunk

+Lateral curvature in the frontal plane
○ Axial rotation in the horizontal plane
○ Disturbance of the sagittal plane normal curvatures, kyphosis and lordosis, usually, but not always, reducing them in direction of a flat back

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presenting from birth through age 21

0-2

Infantile scoliosis

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presenting from age 3 through age 9+11

3-9

Juvenile scoliosis

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presenting from age 10 through age 17+11

10-17

Adolescent scoliosis

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presenting from age 18 & beyond

18+

Adult scoliosis

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absence of idiopathic curvature associated with degenerative changes and collapse of sagittal and coronal balance;

de novo Scoliosis

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more debilitating d/t bone development will also cause progression of abn curvature of spine)

de novo Scoliosis

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most common form of scoliosis!

Adolescent idiopathic scoliosis (AIS)

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spine deformity that is present before 10 years of age

Early Onset Scoliosis (EOS)

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Cobb deg: up to 20

low

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Cobb deg: Moderate

21-35

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Cobb deg: 36-40

moderate to severe

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Cobb deg: severe

41-50

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Cobb deg: 51-55

severe to very severe

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postural or functional scoliosis since there is no bony deformity!

Nonstructural

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Not progressive and reversible type of scoliosis

Nonstructural

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type of scoliosis which is Easily correctable once the cause is determined (treatment and rehab procedures can be done)

Nonstructural

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type of scoliosis which is caused by muscle guarding or spasm from a painful stimuli in the back or neck, and habitual or asymmetrical postures, hysteria, nerve root irritation, inflammation, or compensation caused by leg length discrepancy or contracture (in the lumbar spine)

Nonstructural

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type of scoliosis which shows segmental limitation, and side bending is usually symmetrical

Nonstructural

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type of scoliosis which disappears on forward flexion

Nonstructural

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type of scoliosis which usually found in the cervical, lumbar, or thoracolumbar area ○ can be changed with forward or side bending and with positional changes, such as lying supine, realignment of the pelvis by correction of a leg-length discrepancy, or with muscle contractions

Nonstructural

type of scoliosis which

Structural

type of scoliosis which

Structural

type of scoliosis which

Structural

type of scoliosis which

Structural

type of scoliosis which primarily involves bony deformity

Structural

type of scoliosis which often progressive and irreversible

Structural

type of scoliosis which is Genetic, idiopathic or congenital

Structural

type of scoliosis which is Structural change in bone & normal flexibility of spine is lost

Structural

type of scoliosis which is Rotation of the vertebral bodies is toward the convexity of the curve

Structural

type of scoliosis which caused by neuromuscular diseases or disorders (e.g., cerebral palsy, spinal cord injury, progressive neurological or muscular diseases), osteopathic disorders (e.g., hemivertebra, osteomalacia, rickets, fracture), and idiopathic disorders

Structural

type of scoliosis which is patient lacks normal flexibility, and side bending becomes asymmetrical

Structural

type of scoliosis which is curve does not disappear on forward flexion and a posterior rib hump is detected

Structural

type of scoliosis which is most commonly seen in the thoracic or thoracolumbar spine = ribs rotate with the vertebrae, so there is prominence of the ribs posteriorly on the side of the spinal convexity and prominence anteriorly on the side of the concavity.

Structural

type of scoliosis which is 75% to 85% of all cases of structural scoliosis

Idiopathic scoliosis

type of scoliosis which vertebral bodies rotate into the convexity of the curve with the spinous processes going toward the concavity of the curve

Idiopathic scoliosis

type of scoliosis which disc spaces are narrowed on the concave side and widened on the convex side

Idiopathic scoliosis

pattern of scoliosis which deviation is in the right

DEXTRO scoliosis

pattern of scoliosis which deviation is in the left

LEVO scoliosis

MC scoliotic curve:

DEXTROTHORACIC Scoliosis (85-90% of AIS)

result of double major curve type of scoliosis

C-curve or S-curve:

largest abnormal curves in the spine and the first to development; readily observable

Major or primary curves

considered to develop after major curve or compensation for major curve to maintain balance

Minor or secondary curves

fixed rotational prominence on the convex side, which is best seen on forward flexion from the skyline view

Razorback Deformity

Thoracic scoliosis results in a very poor cosmetic appearance or greater visual defect

Razorback Deformity

Deformation of the ribs along with the spine

Razorback Deformity

Vary from a mild rib hump to a severe rotation of the vertebrae

Razorback Deformity

Based on the extent of development of secondary sexual characteristics that Determines the progression of the scoliosis

Tanner Staging

Tanner stages Stage 1:

prepubertal

Tanner stages Stage 2:

enlargement

Tanner stages Stage 3:

further enlargement

Tanner stages Stage 5:

Mature stage

Critical Threshold in cobbs angle

30° to 50° Cobb’s angle

what happens in critical threshold

Higher risk of health problems in adult life Worst case scenario: compression and malposition of the organs within the rib cage = difficulty in breathing esp pag mas malaki yung Cobb’s angle since may compression of structures thus leading to dec rib expansion pag humihinga!

Bone growth in the period of skeletal immaturity is retarded by mechanical compression on the growth plate and accelerated by growth plate tension.

Hueter Volkmann’s Law

Postural Ax for scoliosis

Plumb line test

what is Plumb line test

confirmatory test and para malaman yung severity (yung thread ididikit mo sa spine and since straight yung thread you will look for asymmetries of the spine);

findings in plumb line test

Asymmetric shoulder level. Rib hump/bump in structural scoliosis Protrusion of hip on one side Pelvic obliquity Inc lumbar lordosis Uneven waist crease.

What is the normal pelvic angle:

30°.

Radiographic eval: measures degree of angulation

Cobb’s Angle

Radiographic eval: measures degree of rotation

Nash-Moe Grading

Radiographic eval: skeletal maturity

Risser Staging

Radiographic eval: a triad classification system that consists of curve type, lumbar spine modifier and sagittal thoracic modifier (orthopedic surgeons need to know this)

Lenke Classification

What is the skin for scoliosis assessment?

+presence of café-au-lait spots (neurofibromatosis); +faun’s beard (spinal dysraphism)

To detect structural or functional scoliosis

ADAM’S FORWARD BENDING TEST

● Ask the patient to bend forward and reach for the toes and look for asymmetry! ● Ask the patient to flex forward at the hips with the fingertips of both hands together so that the arms drop vertically. The feet should be together, and both knees should be straight. Any alteration from this posture will cause the spine to rotate, giving a false view.

ADAM’S FORWARD BENDING TEST

Upon forward bending if rib hump in adams forward bending test

○ (+) = STRUCTURAL | ○ (-) = FUNCTIONAL

What to note for adams forward bending test

○ asymmetry of the rib cage ○ asymmetry in the spinal musculature ○ Presence of pathological kyphosis ○ Whether lumbar spine straightens or flexes as it normally should ○ Whether there is any restriction to forward bending, such as spondylolisthesis or tight hamstrings

Test that is usually done c radiographic findings

LATERAL BENDING TEST

The result of LATERAL BENDING TEST when it Does not disappear on lateral bending

structural scoliosis

The result of LATERAL BENDING TEST when Cobb’s of 25° or more on ipsilateral side-bending radiographic views

STRUCTURAL Scoliosis

Objective measure of spinal curve & rotation

SCOLIOMETER

degree of scoliosis where the risk of progression in adulthood increases, as well as the risk of health problems and reduction of quality of life.”

Over 30°

degree of scoliosis where , there is a consensus that it is almost certain that scoliosis is going to progress in adulthood and cause health problems and reduction of quality of life.

Over 50°

increase in the magnitude of the deformity by more than 5° at consecutive follow-up appointments of between 4 & 6 months.

Curve progression

tx based on cobb angle and deg of progression: Observation = <20

Observation

tx based on cobb angle and deg of progression: Observation = 20-40

Bracing

tx based on cobb angle and deg of progression: Observation = >40

Surgery

tx based on cobb angle and deg of progression: Observation = 40-50 deg

pain + DJD

tx based on cobb angle and deg of progression: Observation = >60 deg

cardiopulmonary changes and life expectancy

wearing a brace mainly in bed (8-12hr/day)

Nighttime Rigid Bracing

wearing a rigid brace mainly | outside school and in bed (12–20 h per day)

Part Time Rigid Bracing

wearing a rigid brace all the time (at school, at home, in bed, etc.)

Full Time Rigid Bracing

Indication for bracing

cobb angle = at least 25 degrees & skeletal immaturity cobb angle = less than 25 degrees but rapidly progressed

Surgery indication

curves exceeding 45 or 50 deg

Brace for Above t6

milwaukee

Brace for Below t6

miami

Brace for Below t8

boston, wilmington, | yamamoto

TECHNIQUES TO INCREASE LATERAL FLEXIBILITY OF THE SPINE: lie prone, stabilize pelvis, reach toward knee with arm on concave side and contralateral arm reach forward; parang pinapaflex mo lang si pt

For thoracic curves

stabilize the thoracic curve by holding on to the edge of the table for mobilization to be on lumbar spine, examiner craddles legs and lateral bend away from concavity

TECHNIQUES TO INCREASE LATERAL | FLEXIBILITY OF THE SPINE: For lumbar curves

heel sitting with abdomen resting on ant thighs, flex both ue forward, then have pt lateral bend away from concave side, hold for 30 secs, 5 reps

TECHNIQUES TO INCREASE LATERAL | FLEXIBILITY OF THE SPINE: For thoracic scoliosis

Scoliosis Flashcards

(95 cards)