Scoliosis is the abnormal twisting and curvature of the spine. It is usually first noticed by a change in appearance of the back. Typical signs include: a visibly curved spine. one shoulder being higher than the other.

1. Dr. Mukesh Sah
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2.  Lateral deviation and rotational deformity of
the spine without identifiable cause.
 Related to hormonal, brain stem or
propioception disorder.
 Positive family history
 Deformity right or left based on the direction of
apical convexity.
 Right thoracic curves most common, followed.
Double major(right thoracic and left lumbar),
left lumbar, and right lumbar curves.
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3.  Risk factors for curve progression.
 Curve magnitudes (>20°)
 Younger age (<12 years)
 Skeletal maturity at presentation
Diagnosis:
1. Standing PA and lateral radiographs –
measure cobb angle method of spine lateral
curvature.
2. MRI Scan – for cases with noted structural
abnormalities on plain films, excessive
kyphosis, juvenile onset (age over 11 years),
rapid curve progressive, neurologic
signs/symptoms, associated syndromes, left
thoracic/thoracolumbar curves.
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4.  Shoulder elevation
 Waistline asymmetry
 Trunk shift
 Limb- length inequality
 Spinal deformity
 Rib rotational deformity(rib hump)
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5.  Based on the maturity of the patient (riser age
and presence of menarche), magnitude of
deformity and curve progression.
1. Observation
2. Bracing – help to halt or slow curve progression but
does not reverse the magnitude of the deformity.
- Milwaukee brace, Boston brace
3. Surgery – anterior spinal fusion w/ instrumentation
- indications are severe deformities (>75°)
and crank shaft prevention (girls < 10 and boys < 13
years old, before or during peak growth velocity).
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6. 1. Infantile idiopathic scoliosis - < 34 years old,
left sided thoracic scoliosis, male
predominance, plagiocephaly (skull flattening)
and other congenital defects.
2. Juvenile – 3-10 years old, high risk of curve
progression 70% require treatment; 50% need
bracing and 50% requiring surgery.
3. Adolescent – onset during the adolescent
pubertal growth spurt
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7.  Deformity of spine and trunk at birth.
 After associated w/ other anomalities
2 GENERAL TYPES
1. Defective formation – hemivertebra
2. Defective segmentation – unsegmental bar
Assessment: examine the entire child and rule out
associated anomalies.
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8. Imaging Studies: X-Rays of spine
MRI
Natural History: 50- 75% curve progression
determine by the following factors:
1. Type of congenital deformity of the vertebrae
2. Location of the deformity
3. Balance of curve
4. Age of patient
5. Severity of curve
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9. 1. Observation
2. Physical therapy – passive stretching, postural
3. Brave – milwaukee in long (8-10 vertebrae)
and flexible (≥50%)
- prevent curve progression
4. Surgery – fusion/ instrumentation
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10. Postural scoliosis – long TL Curve w/ no
compensatory curves and rotation.
o Flexible
o Postural exercise
Functional scoliosis – desparity of the lower limb
lengths.
o Single, long TL curve
Scoliosis due to intrapelvic obliquity:
o Adduction or abduction contracture of the hip.
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16.  Normal in children < 2 years old
 X-ray in physiologic bowing shows flaring of
tibia and femur in symmetric fashion.
 Cause of genu varium includes osteogenesis
imperfecta, osteochondromas, trauma,
dysplasias, blounts disease.
 Blount's disease (tibia varum)
1. Infantile Blount's – 0-4 years old
 More common
 Affects both extremities
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17.  Common in overweight child who begins walking
at < 1 year of age
 X-ray shows metaphyseal – diaphyseal angle
abnormality and metaphyseal beaking.
 Txt – bracing
Proximal tibia fibula valgus osteotomy
epiphysiolysis
2. Adolescent Blount's - >10 years old
 Less severe and often unilateral.
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21.  Up to 15 at the knee is common in 2-6 year old
 Patient w/in physiologic range do not require
treatment.
 Pathologic genu valgum associated w/ renal
osteodystrophy, tumors, infection or trauma.
 Surgery - >10 years old with >10cm between
the medial malleoli or >15-20°of valgus.
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29.  3 deformity: forefoot adduction, hind foot
equinous, varus.
 Talar neck deformity (medial and plantar
deviation) with medial rotation of the
calcaneus and medial displacement of the
navicular and cuboid.
 More common in males
 Half the cases are bilateral
 Associated w/ shortened/ contracted muscle
(intrinsics, tendoachilles, tibialis posterior,
flexor hallucis longus, flexor digitorum
longus), joints capsules, ligaments and fascia.
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30. Radiographs:
1. Dorsiflexion lateral views (turco’s) – talocalcaneal
angle < 30°
2. AP view – talocalcaneal angle <20°
Treatment:
1. Ponsetti method of serial casting – serves of long leg
plaster casts and possible achilles release and its
followed by external rotation of the feet in boots
and bars.
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31. 2. Surgery
6-9 months – surgical soft- tissue release w/ tendon
lengthening is favored in resistant feet.
3-10 years old – media/ opening or lateral column
shortening osteotomy or cuboidal
decancellization
8-10 years – triple arthrodesis
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32. STRUCTURE PROCEDURE
Achilles tendon - Z- lengthening
Calcaneal – fibular ligament - Release
Posterior talofibular ligament - Release
Posterior tibialis tendon - Z–lengthening
Flexor digitorum longus tendon - Z–lengthening
Superficial deltoid - Release
Flexor hallucis longus - Z-lengthening
Tibiotalar, subtalar capsule - complete release
Talonavicular tibionavicular - Release
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