4 – Spine deformities: Difference between revisions

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(Created page with "== Basics of spine == * Curvatures ** Lordosis – concave (inward) ** Kyphosis – convex (outward) ** Scoliosis – deformity in all 3 planes (not just sideways) *** Lateral curvature in the coronal plane *** Lordotic deviation in the sagittal plane *** Vertebral rotation in the horizontal plane ** Normal: *** Cervical lordosis *** Thoracic kyphosis *** Lumbar lordosis == Basics of scoliosis == * Scoliosis – deformity in all 3 planes (not just sideways) ** Lateral...")
 
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*** By physiotherapy and exercise
*** By physiotherapy and exercise
*** Surgery not required
*** 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)]]
[[Category:Orthopaedics (POTE course)]]