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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)]] |