detailed presentation about scoliosis diagnosis and managemant

1. scoliosis
By:-
Mohammed Niyas

2. Scoliosis
• Scoliosis is a lateral (toward the
side) curvature in the normally
straight vertical line of the
spine.
• When viewed from the side, the
spine should show a mild
roundness in the upper back
and shows a degree of
swayback (inward curvature) in
the lower back.

3. • Dextroscoliosis describes a
spinal curve to the right
("dextro" = right). Usually
occurring in the thoracic spine,
this is the most common type of
curve. It can occur on its own
(forming a "C" shape) or with
another curve bending the
opposite way in the lower spine
(forming an "S").
• Levoscoliosis describes a spinal
curve to the left ("levo" = left).
While common in the lumbar
spine, the rare occurrence of
levoscoliosis in the thoracic
spine indicates a higher
probability that the scoliosis
may be secondary to a spinal
cord tumor

4. Types of scoliosis:
• Idiopathic
• Most common type (65%)
• Idiopathic scoliosis which has no definite cause.
Idiopathic scoliosis is broken down by age group:
• infant (0 to 3 years)
• juvenile (4 to 10 years)
• adolescent (11 to 18 years)
• adult (18+ years)

5. Congenital:
• Failure of formation - This may be either partial (wedge vertebra) or complete
(hemivertebra)
• Top left: anterior central defect.
• Top right: incarcerated hemivertebra.
• Bottom left to right: free hemivertebra,
wedge vertebra, and multiple hemivertebrae.

6. • Failure of segmentation - This may be either unilateral (unilateral unsegmented
bar) or bilateral (block vertebra)
• Left: block vertebra.
• Right: unilateral unsegmented bar.

7. • Mixed (see the third image below) - This type includes elements of
both failure of formation and failure of segmentation
• Mixed vertebral deformity involving the thoracolumbar spine.

8. Neuromuscular
• The neuropathic conditions subdivided into
those with upper and lower motor neuron
lesions.
• The upper motor neuron lesions includes
diseases such as cerebral
palsy, syringomyelia, and spinal cord
trauma;
• The lower motor neuron lesions
includes poliomyelitis and spinal muscular
atrophy.
• The myopathic conditions
• Arthrogryposis, muscular dystrophy, and
other forms of myopathy.

9. Degenerative scoliosis.
• This may result from traumatic
(from an injury or illness) bone
collapse, previous major back
surgery, osteoporosis (thinning
of the bones).

10. Signs and symptoms
• Diminishing lung capacity,
• Pressure exerted on the heart,
• Restricted physical activities,
• Uneven musculature on one side of the spine
• A rib prominence or a prominent shoulder blade, caused by rotation
of the ribcage in thoracic scoliosis
• Uneven hips, arms or leg lengths
• Slow nerve action

11. Physical examination
• For the examination, thepatient should be undressed to the waist or wear
abathing suit and a routine should be followed.
• Theshoulders and iliac crest are inspected to determinewhether they are at the
same level.
• The scapulae,ribcage and flanks are then observed for symmetry.
• The spinous processes are palpated to determine their alignment.
• Rib hump or abnormal paraspinal muscular prominence indicates spinal rotation.
• Rib hump leads to asymmetry of the trunk and is called angle trunk rotation
(ATR). It is measured by using a scoliometer.
• The patient is then made to bend forward to see for the disappearance of the
curve (Adam’s test).

12. • Imaging
• X-ray: uses radiation to create a picture
of the spine
• MRI: uses radio and magnetic waves to
get a detailed picture of bones and
tissue surrounding them
• CT scan: X-rays taken at a variety of
angles to get a 3D picture of the
skeleton
• Bone scan: a solution that is
radioactive is injected into your blood. It
will be concentrated in area of
increased circulation, making spinal
abnormalities easier.

13. Treatment
• Scoliosis treatment decisions are primarily based on two factors:
• The skeletal maturity of the patient (or rather, how much more growth
can be expected)
• The degree of spinal curvature.
• There are three main scoliosis treatment options for adolescents:
• Observation
• Back braces
• Scoliosis surgery

14. Cobb method
• The upper and lower vertebrae are
identified. The upper end vertebra is the
highest one whose superior border
converges towards the concavity of the
curve and the lower end vertebra is the
one whose inferior border converges
towards the concavity.
• Intersecting perpendicular line from the
superior surface of the superior end
vertebrae and from the inferior surface
of the inferior end vertebrae is drawn.
• The angle of deviation of these
perpendiculars from a straight line is the
‘angle of the curve’.

15. • Reisser’s sign: This is a classification of the ossification of the iliac epiphysis, which
usually starts from the anterior superior iliac spine and progresses posteriorly towards the
posterior iliac spine.
• Reisser’s stage 4 corresponds with cessation of spine growth and stage 5 correlates with
cessation of height increase.
Reisser’s classification
It uses ossification of iliac apophysis to grade the
remaining skeletal growth.
The ossification progresses
from lateral to medial:
 Type I — Ossification of lateral 25 percent
 Type II — Ossification of lateral 50 percent
 Type III — Ossification of lateral 75 percent
 Type IV— Ossification of lateral 100 percent
 Type V — Fusion of ilium

16. Braces
• Made of polypropylene.
• Contoured to size and shape of body.
• Curved to oppose specific points of
scoliosis curvature.
• Flexible and comfortable.
• Worn under clothing.
• Nighttime/daytime use.

17. Bracing
• Duration and time in brace
• 23 hours per day
• Wear until skeletally mature
• Types
• Milwaukee
• Underarm orthosis
• Electrical stimulation

18. Surgery
• Failed bracing
• Curves >45 degrees
• Unbalanced curves >40 degrees
• Surgery is fusion with
instrumentation

19. Surgical Options:
• Infantile and juvenile scoliosis:
<8 yrs- instrumentation without fusion.
After 8 years- anterior and posterior spinal fusion.
After 11 years- posterior spinal fusion.
• Adolescent scoliosis:
Posterior spinal fusion with instrumentation.
Anterior spinal fusion if younger than 11 years
and with open triradiate cartilage.

20. References:
• http://www.webmd.com/osteoarthritis/guide/arthritis-
scoliosis?page=2
• http://www.spine-health.com/conditions/scoliosis/scoliosis-
treatment
• http://www.healthline.com/symptom/scoliosis
• https://www.uichildrens.org/treating-scoliosis