Basics of spinal deformity البروفيسور فريح ابوحسان- استشاري جراحة العظام والعمود الفقري- تشوهات العمود الفقري

Professor of Orthopaedics
1/15/2011 ١Professor Freih Abuhassan -
University of Jordan

1/15/2011 ٢Professor Freih Abuhassan -

1/15/2011 ٣Professor Freih Abuhassan -

1/15/2011 ٤Professor Freih Abuhassan -

1/15/2011 ٥Professor Freih Abuhassan -

1/15/2011 ٦Professor Freih Abuhassan -

• Scoliosis:• Scoliosis:
Lateral curvature of the spine.Lateral curvature of the spine.
(reversible lateral curvature with out
rotation) !!!!!!!rotation) !!!!!!!
• Structural Scoliosis:
Irreversible lateral curvature of the spine with
rotation of the vertebral bodies in the area of the
major curve. 3D
1/15/2011 ٧Professor Freih Abuhassan -

•Major curve:•Major curve:
Th l lThe largest structural curve.
C t• Compensatory curve:
A h i b b l jA curve that is above or below a major
curve that serves to maintain normal
body alignment.
1/15/2011 ٨Professor Freih Abuhassan -

1/15/2011 ٩Professor Freih Abuhassan -

1/15/2011 ١٠Professor Freih Abuhassan -

Frontal plane (X-ray)Frontal plane (X ray)
*< 10 degrees of lateral spinal
d i tideviation
*< 2 cm of trunk shift level
pelvis & shoulders
1/15/2011 ١١Professor Freih Abuhassan -

Sagittal planeSagittal plane
Thoracic spine
Kyphosis : 25 - 45 deg.
Thoracolumbar junction
10 10 d-10 to +10 degrees
lumbar spine
l d i 25 t 65 dlordosis 25 to 65 deg.
1/15/2011 ١٢Professor Freih Abuhassan -

lateral deviation of the
spine?! with measured
curvature of greater thancurvature of greater than
10 degrees on
di hi l iradiographic analysis
1/15/2011 ١٣Professor Freih Abuhassan -

1/15/2011 ١٤Professor Freih Abuhassan -

1/15/2011 ١٥Professor Freih Abuhassan -

1/15/2011 ١٦Professor Freih Abuhassan -

1/15/2011 ١٧Professor Freih Abuhassan -

Crooked tree
1/15/2011 ١٨Professor Freih Abuhassan -

1/15/2011 ١٩Professor Freih Abuhassan -

G CGreek = Crooked
Ist used by Galen 131 201 A DIst used by Galen 131-201 A.D
1/15/2011 ٢٠Professor Freih Abuhassan -

Prevalence of Scoliosis
School screeningSchool screening
Physical exam 8-10% suspicious!y p
1.1% to 4.1% X-ray confirmed
li i F/M ti 5 10 1scoliosis F/M ratio 5-10:1
1/15/2011 ٢١Professor Freih Abuhassan -

Structural
Idiopathic
Neuromuscular
CongenitalCongenital
MetabolicMetabolic
Tumor, Trauma
1/15/2011 ٢٢Professor Freih Abuhassan -

Non-structural
Postural
LLDLLD
InflammatoryInflammatory
Infection
Tumor
1/15/2011 ٢٣Professor Freih Abuhassan -

Eti l f S li iEtiology of Scoliosis
Idiopathic: no single clear etiology
*G i*Genetic – familial prevalence, twins
*Hormonal – progressive forms much more
common in females.
*Connective tissue – histologic changes in
apical tissues, cause or effect ?
*CNS – proprioceptive dysfunction
*Neuromuscular
1/15/2011 ٢٤Professor Freih Abuhassan -

1-Spinous process deviates toward thep p
concave side.
2 The vertebral body rotates toward2-The vertebral body rotates toward
the convex side.
3-Ribs become closer together on the
concave side and separated on theconcave side and separated on the
convex side.
1/15/2011 ٢٥Professor Freih Abuhassan -

1/15/2011 ٢٦Professor Freih Abuhassan -

Pathophysiology ?Pathophysiology ?
S i l thSpinal growth
Ligamentous laxity, hormonal changes
–Rotational deformation–Rotational deformation
–Progressive
•rotation
•translation•translation,
•complex 3D deformity
1/15/2011 ٢٧Professor Freih Abuhassan -

1/15/2011 ٢٨Professor Freih Abuhassan -

Muscle Power Testing (MRC Scale
0 Total paralysisp y
1 Barely detectable contracture
2 N t h t t i t it2 Not enough to act against gravity
3 Strong enough to act against gravity3 Strong enough to act against gravity
4 Still stronger but less than normal
5 Full power
1/15/2011 ٢٩Professor Freih Abuhassan -

1/15/2011 ٣٠Professor Freih Abuhassan -

Imaging for spinal problemsImaging for spinal problems
Computed tomography (with myelo.)Computed tomography (with myelo.)
Plain x-rays
AP d l t l i– AP and lateral views
– Oblique views
– PA view in females !!!!!
MR imagingMR imaging
Radioisotope scanning
Di h & f t j i t th hDiscography & facet joint arthrography
1/15/2011 ٣١Professor Freih Abuhassan -

Ca da Eq ina S ndromeCauda Equina Syndrome
Large midline compression e.g disc
Compresses several nerve roots
Sphincter disturbance
Saddle anaesthesiaSaddle anaesthesia
Prompt surgical interventionp g
1/15/2011 ٣٢Professor Freih Abuhassan -

S d l li th iSpondylolisthesis
Forward slippage of
one vertebralone vertebral
body on another
1/15/2011 ٣٣Professor Freih Abuhassan -

KyphosisKyphosis
Sagittal plane deformity in the
thoracic or thoracolumbar spine
Postural (Round back)
Compensatory
Structural
1/15/2011 ٣٤Professor Freih Abuhassan -

1/15/2011 ٣٥Professor Freih Abuhassan -

1/15/2011 ٣٦Professor Freih Abuhassan -

Basics of spinal deformity البروفيسور فريح ابوحسان- استشاري جراحة العظام والعمود الفقري- تشوهات العمود الفقري

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Basics of spinal deformity البروفيسور فريح ابوحسان- استشاري جراحة العظام والعمود الفقري- تشوهات العمود الفقري