definition, classification, pathophysiology of scoliosis

1. SCOLIOSIS
Dr. SUSHIL KUMAR NAYAK
DNB PGT 1Y.
PM&R

2. • ANATOMY
• DEFINITIONS
• TYPES OF PATHOLOGICAL CURVES
• ETIOPATHOGENESIS
• TYPES OF SCOLIOSIS

3. BODY PLANES

4. Three columns for the price of one

5. ANATOMY

6. DEFINITIONS
• The term scoliosis is derived from Greek word
–skolio meaning any bend or twist.
• Galen defined it as abnormal curve in coronal
plane.
• Scoliosis is a lateral curvature of the spine
usually with rotational elements.

8. PATHOLOGICAL SPINAL CURVES
• The Scoliosis Research Society (SRS)has
defined a medically significant frontal plane
curve(scoliosis)as any curve which is greater
or equal to 10⁰ with or without a rotatory
component.

9. PLUMB LINE
• The curve in sagittal
plane is less settled.
• The spine is balanced in
the sagittal plane along a
plumb line dropped from
the centre of C7 to the
sacral promontory..

10. Other terminologies
• Kyphosis is derived from Greek word “kuphos”
meaning bend forwards or humped.
• Galen coined the term kyphosis as any sagittal
curve having posterior vertex..
• Lordosis Greek word “lordós” is bending
backwards
• It is used for anterior vertex in any sagittal
curve..

11. • According to Scoliosis Research Society(SRS):
Normal thoracic kyphosis ranges 20⁰ to 50⁰.
Normal lumbar lordosis ranges 31⁰ to 79⁰.

13. • Abnormal kyphosis:-
Hyperkyphosis(round back)
Hypokyphosis (flat back)
• Abnormal lordosis:-
Hyperlordosis (swayback)
Hypolordosis(flat back)

15. HUMP BACK (GIBBUS) DOWAGER ‘S HUMP

16. • Primary curve-earliest curve to appear.
If 3 curves: middle one usually primary.
If 4 curves: middle 2 are usually primary.
• Secondary or compensatory curve-curve
which develops above or below the primary
curve in an effort to balance the spine.

17. • Decompensated curve- compensatory curve
doesn’t fully balance the primary one.
• Overcompensated curve-compensatory curve
more than primary curve.
• Major curve-largest structural curve.
• Minor curve-smallest curve.
• Double major curve-scoliosis with two
structural curves.

19. • Apical vertebra- most deviated vertebra from
the vertical axis of the patient.
• End vertebra- the uppermost /the lowermost
vertebra whose superior surface or inferior
surface respectively tilts maximally towards
the concavity of the spine.

20. Cervical C1-C6
Cervicodorsal C7-T1
Thoracic T2-T11
Thoracolumbar T12-LI
Lumbar L2-L4
Lumbosacral L5-S1
APICAL VERTEBRACURVES

22. CLASSIFICATION OF SCOLIOSIS
• Scoliosis is broadly divided into structural or
non-structural.
• Structural variety is not correctable
completely.
• Instead non-structural is correctable fully.

23. STRUCTURAL TYPES

24. IDIOPATHIC TYPES
A. Infantile (›3 yrs)
1. Resolving
2. Progressive
B. Juvenile (3-10 years)
C. Adolescent (10 years to 18 years)

25. NEUROMUSCULAR TYPE
Neuropathic
I. Upper motor neuron
I. Cerebral palsy
II. Spinocerebellar degeneration
A. Friedreich’s disease
B. Charcot-Marie-Tooth disease
C. Roussy-Levy disease
III. Syringomyelia
IV. Spinal cord tumor
V. Spinal cord trauma
VI. Other
II. Lower motor neuron
I. Poliomyelitis
II. Other viral myelitidies
III. Traumatic
IV. Spinal muscular atrophy
A. Werdnig-Hoffman
B. Kugelberg-Welalander
V. Myelomeningocoele (paralytic)
VI. Dysautonomia (Riley-Day)
VII. Other
Myopathic
I. Arthrogryposis
II. Muscular dystrophy
I. Duchenne
(pseudohypertrophic)
II. Limb-girdle
III. Facioscapulohumeral
III. Fiber-type disproportion
IV. Congenital hypotonia
V. Myotonia dystrophica
VI. Other

26. CONGENITAL SCOLIOSIS
Failure of formation(type 1)
Wedge vertebra(partial)
Hemivertebra(complete):- segmented
semisegmented
Incarcerated
nonsegmented
Failure of segmentation(type2)
Partial (unsegmented bar)
Complete(Bloc vertebra)
Mixed(type3)

29. 1. Neurofibromatosis
2. Mesenchymal disorders
1. Marfan’s
2. Ehlers-Danlos
3. Others
3. Rheumatoid disease
4. Trauma
1. Fracture
2. Surgical
1. Postlaminectomy
2. Postthoracoplasty
3. Irradiation
5. Extraspinal contractures
1. Post-empyema
2. Post-bums
6. Osteochondrodystrophies
1. Diastrophic dwarfism
2. Mucopolysaccharidoses (for
example, Morquio’s
3. syndrome)
4. Spondyloepiphyseal dysplasia
5. Multiple epiphyseal dysplasia
6. Other
1. Infection of bone
1. Acute
2. Chronic
2. Metabolic disorders
1. Rickets
2. Osteogenesis imperfecta
3. Homocystinuria
4. Others
3. Related to lumbosacral joint
1. Spondylolysis and
spondylolisthesis
2. Congenital anomalies of
lumbosacral region
4. Tumors
1. Vertebral column
1. Osteoid osteoma
2. Histiocytosis X
3. Other
2. Spinal cord

30. NONSTRUCTURAL TYPES
A. Postural scoliosis
B. Hysterical scoliosis
C. Nerve root irritation
Herniation of nucleus pulposus
Tumors
D. Inflammatory causes
E. Related to leg length discrepancy
F. Related to contractures about the hip

31. PATHOPHYSIOLOGY OF SCOLIOSIS

32. GENETICS
• Notch signaling pathway and its interaction
with FGF & Wnt signaling in the process of
somitogeneis in congenital scoliosis.
• CHD7 gene on 15q26.1 chromosome is
responsible for idiopathic scoliosis.(kulkarni
et al)

33. • References:
Delisa’s PM&R
Rothmore’s “The Spine”
David J.Magee’s “Orthopedic physical
assessment”

34. THANK YOU