This document provides information on orthotic management of scoliosis. It defines scoliosis as a lateral curvature of the spine greater than 10 degrees with vertebral rotation. The document describes different types of scoliosis including congenital, idiopathic, neuromuscular, and degenerative. Treatment options include observation for mild curves, bracing for curves between 25-40 degrees using devices like TLSO or Milwaukee braces, and surgery for curves over 40 degrees. Bracing aims to prevent curve progression until skeletal maturity and has been shown to successfully treat some curves.

1. ORTHOTIC MANAGEMENT OF
SCOLIOSIS
Prepared by:
MUHAMMAD IBRAHIM KHAN
BS.PT(Pak), MS.PT(Pak), NCC(AKUH)

3. Scoliosis
– 3-dimensional deformity of the
spine affecting all the 3 planes.
– Can be difficult to visualize with
2-dimensional radiographs
– Scoliosis is a lateral deviation of
the normal vertical line of the
spine which, when measured by
an X-ray, is greater than 10
degrees accompanied by vertebral
rotation.

4. Scoliosis
“Normal” alignment
• Spinous processes all line up in
a straight line over the sacrum
Scoliosis is a combination of
• Angular displacement
• Lateral displacement

5. Scoliosis
• Lateral displacement

6. Scoliosis
• Angular displacement

7. Genetics
• 11% incidence in first relatives of patients
– Normal incidence < 3%
• Monozygote twins more common
• No gene identified to date

8. Degrees of Curvature
MILD MODERATE SEVERE

9. Types of Scoliosis
• Congenital
• Idiopathic
• Neuromuscular
• Post Traumatic
• Infective
• Degenerative
• Inflammatory
• Tumor

10. CONGENITAL SCOLIOSIS
The critical time is the time of segmentation
process (First Six weeks) and congenital
anomalies develop during this period of time.
In the presence of vertebral anomalies, there
is an imbalanced growth of spine resulting in
congenital scoliosis.

11. Classification
By MacEwen et al. later modified by Winter, Moe, and Eilers
• FAILURE OF FORMATION
Partial failure of formation (wedge vertebra)
Complete failure of formation (hemi vertebra)
• FAILURE OF SEGMENTATION
Unilateral failure of segmentation (unilateral un segmented
bar)
Bilateral failure of segmentation (block vertebra)

12. Congenital Scoliosis
Failure of Formation Failure of Segmentation

13. Patient Evaluation
 Examine the skin of back for hair patches,
dimples, and scars.
 Look for the evidence of neurological
involvement, such as clubfoot, calf
atrophy, absent reflexes and atrophy of one
lower extremity compared with the other.
 Look for the other congenital anomalies.

14. Screening hints
• Shoulders are different heights
• Head is not centered directly
above the pelvis
• Appearance of a
raised, prominent hip
• Rib cages are at different
heights
• Uneven waist
• Changes in look or texture of
skin overlying the spine
(dimples, hairy patches, color
changes)
• Leaning of entire body to one
side

15. Scoliometer
An inclinometer (Scoliometer) measures
distortions of the torso.
•The patient bends over, arms dangling
and palms pressed together, until a curve
can be observed in the upper back
(thoracic area).
•The Scoliometer is placed on the back
and measures the apex (the highest
point) of the upper back curve.
•The patient continues bending until the
curve can be seen in the lower back
(lumbar area). The apex of this curve is
also measured.

16. Adam’s forward bend test
For this test, the patient is asked to lean forward with
his or her feet together and bend 90 degrees at the
waist. The examiner can then easily view from this
angle any asymmetry of the trunk or any abnormal
spinal curvatures.

17. Measure spinal curvature using
Cobb method
- Choose the most tilted
vertebrae above & below
apex of the curve.
- Angle b/w intersecting lines
drawn perpendicular to the
top of the superior vertebrae
and bottom of the inferior
vertebrae is the Cobb angle.

19. Diagnosis
• Physician Physical Exam
• Scoliometer measurements
• X Ray
• MRI

20. Scoliosis Treatment
• Observation Spinal curvature<25
• Brace Spinal curvature 25-40
• Surgery Spinal curvature >40

21. Observation
 Non progressive curves and Minor curves (>20
degrees) and with other congenital anomalies.
 Skeleton is close to maturity
 Exercises may help with surrounding muscular
strength.
 Limited value in patients with congenital
scoliosis.

22. ORTHOTIC MANAGEMENT

23. Bracing
• Usually works on the vertebrae outside the
actual congenital deformity.
• Compensatory curves also can be successfully
managed for several years with orthotic
treatment.
• Lumbar curves can be treated in a TLSO, but
thoracic curves require a Milwaukee brace.

24. Bracing
• Duration and time in brace
– 23 hours per day
– Wear until skeletally mature

25. Bracing
Types
– Milwaukee
– Thoraco-lumbar-sacral orthosis (TLSO or Boston
brace)
– Charleston night time bending brace

26. Bracing
• TLSO Brace

27. Bracing
Milwaukee Brace

28. Bracing
Charleston night time bending brace

29. Bracing
Milwaukee brace
Three types of curves respond to brace
management:
1- Long, flexible curves,
2- Curves that could be corrected either in
traction or on side bending,
3- Curves with a mixture of anomalous and
non-anomalous vertebrae.

30. Successful Bracing
• Prevent curve progression
– Randomized study
• Braced 74% did not progress
• Not braced 34% did not progress
• Charleston brace still controversial

31. Problems with Braces
• Argued efficacy
• Narrow treatment window to initiate
• Poor compliance
• Must have good orthotist
– Curves corrected by 20 degrees in brace do better

32. SURGERY