1) The document discusses the anatomy and structure of the spine as well as common spinal deformities like scoliosis. 2) Scoliosis is a lateral curvature of the spine that is usually accompanied by some rotational deformity. It can be classified based on cause and location. 3) Treatment depends on the severity and progression of the curvature and may involve bracing, casting, or surgery to correct or prevent worsening of the deformity.

1. Head of the departmentof traumatology and
orthopaedics
of the National Medical University
named after.O.O Bogomolets ,
Doctor of Medical Science, Professor A. A. Buryanov
The congenital and acquired diseases of
spine
Lecture:

2. Anatomical structure of spine
anterior longitudinal ligament
posterior longitudinal ligament which is weak
cervical
lordosis
thoracic
kyphosis
lumbar
lordosis
sacral
kyphosis
Normal spinal curves
intervertebral disc
facet joint

3. Forward basic complex
Back stabilizing complex
Interspinous
ligament
Ligamentum
flavum
spinous process
supraspinous
ligament
intervertebral
foramen
pedicle

4. The disc consists of two parts, centrally it is nucleus pulposus
Peripherally it has annulus fibrosus
Vertebral motorial segment - structural and a functional unit of a backbone.
Includes: disc, 2 adjacent vertebraes, ligaments
foramen
bodyarticular facet
inferior
superior
Intervertebral

5. ABOUT SPINE
• It is the principal load bearing structure of the
head and torso.
• Each portion of the spine has specific functions:
Cervical spine provides head with limited mobility
and protects proximal part of spinal cord. Thoracic
spine provides mobility to the upper torso and rib
cage and protects the cord.
Lumbar spine provides the lower torso, its mobility
and protects the cord.
• Like the skull which protects the brain, spinal
column protects the cord.
• Spine should be flexible yet strong.

6. Remember
Factors keeping the spine healthy
• Genetics
• Muscle strength and balance
• Flexibility
• Posture
• Body weight
• Adaptation to stresses

7. normal bad posture
The features of normal posture are
as follows:
• Moderate lordosis of cervical
and lumbar spines.
• Kyphosis of the thoracic and
sacrococcygeal sections.
• Forward pelvic inclination of
30°.
• Neutral rotation of femur.
• Plumb line dropped from the
mastoid process passes through
the middle of the shoulder and
hip, just anterior to the knee and
lateral malleolus of the ankle.

8. Postural scoliosis
the curves are flexible and readily correctible with side bending.

9. The congenital diseases of spine
Cervical spina bifida
half- vertebraes
Butterfly - shaped vertebraes

10. osteal torticollis
Union
vertebraes
(concretion)

11. Сколіоз
SCOLIOSIS

13. SCOLIOSIS
is the lateral curvature of the spine in the upright
position. The lateral curvature is usually accompanied by
some rotational deformity.
The curves are fixed and nonflexible and fail to correct with
side bending. Lateral bending of spine is asymmetric or
involved vertebrae are fixed in a rotated position or both.
The following problems:
1. A cosmetically unacceptable deformity.
2. Deranges the load and force transmission mechanism
through the spine.
3. Jeopardizes the functions of vital organs like lungs, heart by
overcrowding the ribs.
4. Managing it is cumbersome and unrewarding experience
most of the times.

14. Deformation of spine and thorax
•Costal hibbus on the convex side of a curvature;
•Retraction ribs on the concave side of a curvature;
•High standing domes of a diaphragm;
•Disposition of heart and lungs.

15. Left-side SCOLIOSIS

16. Right-hand thoracic SCOLIOSIS

17. Reduction of pleural cavities and
disturbance of mechanics of breath owing
to rapproachement of ribs on the concave
and convex sides of deformation result in
development of sites atelectasis and
vicarious emphysema
It is the starting mechanism of
development of disturbance of external
breath
Scoliotic disease

18. Atelectasis and vicarious emphysema of lung
and also a spasm pulmonary capillaries
result in difficulty of a blood-groove in system
pulmonary arteries.
_______________________________________
The hypertensia in a small circle of blood
circulation results in a hypertrophy of a
myocardium and dilatetion cavities of the right
heart that is an attribute of pulmo-cor insufficiency
on type « cor pulmonale ».
Scoliotic disease

19. Adam's Position Posterior
Adam's Position Anterior
Rib hump

20. Minor curve
Major
curve

21. 1. Idiopathic (unknown cause) (75-90%)
• Infantile (70-90%): < 3 years. Curve is progressive or resolving
• juvenile (15%)• 4-10 years Thoracic curve usually to the right
• adolescent. (2-3%) 10-16 years F:M =3,6:1
2. Known cause(10-25%)
a. Congenital scoliosis (This is due to defect in
segmentation defect in the formation including
hemivertebrae or double hemivertebrae).
b. Paralytic scoliosis ( poliomyelitis,cerebral palsies,
muscular dystrophies etc are the other common
causes).
SCOLIOSIS

22. Congenital/paralytic
Neuromuscular scoliosis
• Neuropathic causes Spinal cord injury, poliomyelitis,
progressive neurological disorders, syringomyelia,
myelomeningocele and cerebral palsy are some
of the neuropathic causes.
• Muscular AMC and muscular dystrophy are some of the
important muscular causes.
• Neurofibromatosis
• Miscellaneous Multiple epiphyseal dysplasias, osteogenesis
imperfecta, etc.

23. 1. Cervical C1-C6
2. Cervicodorsal C7-T1
3. Thoracic T2-T11
4. Thoracolumbar T12- L1
5. Lumbar L2-L4
6. Lumbosacral L5-S1
SCOLIOSIS

24. The uppermost vertebra
The lowermost vertebra
Apical vertebra
Major curve
Minor curve
Cobb's method of measuring severity of a curve

25. 1 degree -5-10º
2 degree -11-20º
3 degree –21-40º
4 degree - > 40 º
SCOLIOSIS
Major curve
Index stability scoliosis(I) - a degree fixity(mobility) of deformation.
Angle of deformation α - In position of the patient laying
Angle of deformation β - In position of the patient standing
I = 180 – α / 180- β
Major
curve
I = 0,5-1 → stable deformation ( ↓↓ prognosis)

26. Compensation or secondary curve
develops above or below the primary curve in an effort to balance the spine

27. Generally accepted guidelines
• Curves of less than 20° in skeletally immature persons are
examined every 6 months.
• Curves more than 20° in skeletally immature patients should be
examined every 3 to 4 months. Orthotic treatment for curves more
than 25°.
• Curves less than 20° in skeletally mature persons require no
further evaluation.
• Curves more than 30 to 40°in skeletally mature persons do not
require treatment. But they are examined radiographically for
progression -every 2 to 3 years.
Treatment

28. Orthotic treatment Milwaukee Brace, Boston Brace,
Reisser's turn buckle cast, localiser cast etc.

29. Risser 4 The importance of this sign is, the completion
of growth can be radiologically assessed which indicates
no possibility of the curve progression.

30. 1. Distraction Techniques
(rarely used)
Methods
Halopelvic distraction
Halofemoral distraction
Surgical treatment is indicated:
•for high degree thoracic curve
•сasts are not effective in thoracic spine.
• curve is over 40°
2. Fusion
Methods
a. Anterior Fusion
b. Posterior Fusion
• Harrington's
instrumentation
• Dwyer's
instrumentation
• Zielke's
Instrumentation.
1 Hartshill rings, etc.

31. Posterior Fusion
Distracter Kazmina
(Russian)
Harrington's instrumentation

32. Method
Katrel-Dubasseta

33. Quick facts
•Scoliosis is lateral curvature of the spine.
•Idiopathic variety accounts for 90% of cases.
•Female preponderance.
•X-ray is the only definite documentation of
curve size and progression.
•The most important aspect of treatment is
early detection.
•Curves < 20° need observation.
•Curves > 20° require treatment.