2. HISTORY:
Hippocrates (460-375 BC): Hippocratic Ladder
Galien (AD 130-200): He first used the
terms Scoliosis, Kyphosis and Lordosis
American named Russel Hibbs (1860-1932), who was the first
surgeon ever to perform a spinal fusion
Dr. Paul Harrington, who in the 1950′s performed for the first time
surgery using the so called Harrington Rod.
3. DEFINITION:
o Skolios”, "crooked
o The Scoliosis Research Society (SRS) : Lateral curvature of the spine
greater than 10° (from Central Axis) as measured by the Cobb method on a
standing x-ray of the thoraco-lumbar spine.
o 2% to 4% of children between 10 and 16 years of age have measurable but
small curves.
4. CLASSIFICATION:
I. Non structural Scoliosis (Lateral Curvature but not such structural abnormality present)
Postural scoliosis
Compensatory Scoliosis
II. Transient structural Scoliosis
Sciatic scoliosis
Hysterical scoliosis
Inflammatory scoliosis
III. Structural scoliosis (Involves both lateral curvature and rotation of the vertebrae)
A. Idiopathic Scoliosis
Infantile
Juvenile
Adolescent
5. CLASSIFICATION Continued:
B. Congenital (Bone abnormality present at birth)
I. Vertebral- Open and Closed
II. Extravertebral
C. Neuromuscular (Abnormal muscle or nerves)
I. Neuropathic
II. Myopathic
III. Others
9. History:
Chronological age
Age at recognition of deformity
Impression of rate of progression
Associated symptoms
Genetic factors
History of measles, mumps, chicken pox, whooping cough, polio, rickets
diphtheria, pneumonia, torticollis, chorea.
11. o All bony elements are
altered
o Vertebrae are wedge shaped
o Poorly developed concave
side
o Pedicles are rotated
o Discs are wedged as well. .
12.
13. RADIOGRAPHIC EVALUATION:
X rays
PA and Lateral views (in standing)
Right and left bending views (evaluation for surgery and bracing)
Stagnara Derotation view- obliterates rotational component
Cobbs angle & Bunnel Method
Nash and Moe Method (Rotation)
Risser sign- Measurement of skeletal maturity
Rib hump
Moire’ topography- Biostereometric method (3 dimensional)
ISIS (Integrated Shape Imaging Systems) Scanning
14. Rib Hump: linear distance between the
left and right post rib prominence- lateral
X ray
Apical vertebral body – rib ratio: Linear
measurements from the apical vertebral
body to the chest wall on AP x ray
21. Scoliometer / Inclinometer: Type of Protractor used to measure the
vertebral rotation and rib humping usually seen in forward bending.
22. GUIDELINES & TREATMENT:
Curve
(degrees) Risser grade X-ray/refer Treatment
10 to 19 0 to 1 Every 6 months/no Observe
10 to 19 2 to 4 Every 6 months/no Observe
20 to 29 0 to 1 Every 6
months/yes
Brace after 25
degrees
20 to 29 2 to 4 Every 6
months/yes
Observe or brace
29 to 40 0 to 1 Refer Brace
29 to 40 2 to 4 Refer Brace
>40 0 to 4 Refer Surgery
28. Exercises in/out of Brace:
Purpose of exercise program (out of brace):
a. Develop postural awareness and ability to maintain corrected alignment.
b. Maintain and/or increase chest mobility for proper respiration.
c. Maintain and/or increase muscle strength.
d. Maintain and/or increase spinal flexibility.
e. Maintain and/or increase range of motion (prevent contractures, especially in hip
flexors).
f. Provide a good general physical condition.
29. Purpose of exercise program (in brace):
a. Develop postural awareness and ability to maintain corrected alignment as
provided by brace
b. Enhance patient’s comfort
c. Assist patient to resume previous activity level.
Functional
Social
Recreational
30. Postural alignment:
Done as frequently as possible, both in and out of brace.
a. Lumbar Flexion (posterior pelvic tilt):
This serves to maintain the anterior-posterior balance of the spine by
elongating the posterior structures and enhancing the contractile elements of
the anterior structures. This keeps the pelvis and lower spine in optimum
alignment as the patient attempts proper trunk alignment.
b. Trunk Alignment Patient attempts to align head, neck and trunk
over pelvis.
31. Points to remember……..
Bracing will reduce lung function by 10 to 15%
Skin care very important
Break-in time for a brace should be about 2-3 weeks
(6 hours, 10 hours and 18-23 hours)
Brace checkout done by orthotist regularly
Each brace to be custom made
33. SCREENING 6 Step Process:
1. Front standing position
2. Back standing position
3. Back bending away from you
4. Side bending position
5. Front bending toward you
6. Side bends
34. Step 1 Front View
• Shoulders should be level and at
the same height
• Distance between arm and torso
equal on both sides
• Crest of hips level on horizontal
plane
• Head straight and centered
35. Step 2 Back Standing
View
• Shoulders should be level and the
same height
• Distance between arm and torso
equal on both sides
• Crest of hips level on horizontal
plane
• Head straight and centered
• Scapula level on both sides
36. Adam’s Bending
Technique
Feet slightly apart
Palms together
Arms outstretched with straight
elbows
Head out
Bend forward at waist
Place hands between legs at knee
level
37. Step 3 Back Bending Away
Look For:
• Rib prominence
• Lumbar Prominence
• Differences in height of hip
crests
38. Step 4 Side View
Look for exaggerated
rounding of the back
Kyphosis
39. Step 5 Bending Front
View
• Shoulders level?
• Is one side of torso more
rounded than the other ?
• Look for lumbar
prominence
40. Step 6 Side Bends
Ask the student to bend
at the waist to each side
Look for S curvatures
41. Management for Postural curves:
General body relaxation
Passive correction
Maintenance of corrected posture
Stretching to tight structure
Strengthening of weak muscles
Deep breathing exercises
Balance exercises
Symmetrical movements should NOT be advised
Ergonomic advice
Aerobic conditioning programme
42. Structural Scoliosis:
Brace
Mobility Exercises
Deep breathing Exercises
Back to wall postural exercises
Stretching
Strengthening
Traction: Hanging on stall bars, skin traction
Hydrotherapy
43. Scientific Exercises Approach to Scoliosis (SEAS)
Postural rehabilitation
Active Self-Correction
Muscular endurance strengthening in the correct posture
(paravertebral, abdominal, lower limbs and scapulo-humeral
girdle muscles)
Development of balance reactions (static and dynamic balance
of the trunk)
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