4 – Spine deformities: Difference between revisions

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 *** By physiotherapy and exercise
 *** Surgery not required
+== 42. Scoliosis with known etiology, treatment of ==
+* Structural scoliosis is secondary in 20% of cases
+* Compared to idiopathic scoliosis, neuromuscular scoliosis involves
+** Pelvic deformities in addition to the spinal deformities
+** Risk of progression independent of growth (after skeletal maturity)
+** Several comorbidities
+** Neurological problems
+** Problems while sitting
+* Etiology
+** Neuromuscular
+*** = causing muscle weakness or asymmetry
+*** Spinal muscular atrophy
+*** Cerebral palsy
+*** Duchenne muscular dystrophy
+** Congenital (abnormal vertebrae)
+*** Wedge vertebrae
+*** Block vertebrae
+*** Hemiblock vertebrae
+** Syndromic
+*** Neurofibromatosis
+**** MRI should be performed to look for neurofibromas
+*** Marfan syndrome
+*** Ehlers-Danlos syndrome
+* Treatment
+** Neuromuscular scoliosis
+*** Growing rods until growth is finished
+*** Spinal fusion surgery (of Luque)
+** Congenital scoliosis
+*** Surgery to correct the congenital abnormality
+** Syndromic scoliosis
+*** Same as for adolescent idiopathic scoliosis
+== 51. Idiopathic structural scoliosis ==
+* Structural scoliosis is idiopathic in 80% of cases
+* Adolescent idiopathic scoliosis (AIS)
+** 11 – 18 years
+** Lenke classification system
+*** The gold standard for classification of AIS
+*** Helps plan surgeries
+** Risser sign
+*** = degree of ossification of the iliac apophysis across the iliac crest
+*** Is used to estimate the skeletal maturity of the vertebral column and to guide treatment
+**** -> more mature = less risk of scoliosis progressing
+**** -> less mature = more risk of scoliosis progressing
+**** Spinal fusion surgery can only be performed on those with mature skeleton
+***** If Risser 2 or lower -> conservative treatment
+***** If Risser 3 or higher -> spinal fusion surgery
+*** Risser 1 = 25% of the iliac crest is ossified
+*** Risser 2 = 50%
+*** Risser 3 = 75%
+*** Risser 4 = 100% of the iliac crest is ossified
+*** Risser 5 = the iliac crest is fused to ileum
+** Skeletal maturity can also be planned based on menarche
+*** We say that 2 years after menarche the skeleton is mature enough for spinal fusion surgery
+** Poor prognostic factors (factors which increase risk of curve progression)
+*** These factors are important to determine how often a check-up should be performed
+*** Female
+*** Age of onset
+*** Greater Cobb angle
+*** Scoliosis of upper spine
+*** Bigger vertebral rotation
+*** Bigger rib-vertebral angle difference (RVAD)
+** Treatment
+*** Conservative
+**** Used for Risser 2 and below while waiting for skeletal maturity, and for < 50 degree Cobb
+**** Schroth therapy
+***** = special 3D training exercises
+***** These exercises not only stops progression but can cause regression of curve
+**** Cheneau brace
+***** Should be worn for 20 hours per day
+***** Must be combined with physical exercise
+***** The brace helps stopping the progression but does not cause regression
+*** Surgery
+**** Posterior instrumented fusion with direct vertebral rotation
+***** A form of spinal fusion surgery
+***** Gold standard
+***** Involves placement of screws and rods
+**** Osteotomies
+***** On rigid spines
+*** Cobb angle 15 – 20 degrees
+**** Night-time brace + Schroth therapy
+**** Only observation (if non-progressive curve)
+*** Cobb angle 20 – 40 degrees
+**** Cheneau brace + Schroth therapy
+*** Cobb angle 50 – 65 degrees -> Surgery
+**** Surgery at this stage corrects the cosmetic problem and prevents later back pain
+*** Cobb angle > 65 degrees -> Surgery
+**** Surgery at this stage not only corrects the cosmetic problem and prevents later back pain, but also prevents severe cardiorespiratory complications
+* Early onset scoliosis
+** Treatment is not based on fusion (as in AIS) but rather uses unilateral growing rods
+** Many cases resolve spontaneously
 [[Category:Orthopaedics (POTE course)]]