This document provides information about scoliosis, including its definition, types, classification, and treatment. Scoliosis is defined as a lateral curvature of the spine combined with vertebral rotation. There are different types classified by cause (idiopathic, congenital), location of curvature, magnitude of curvature (Cobb's angle), and flexibility. Treatment depends on the type and severity of scoliosis, and may include bracing, casting, spinal instrumentation/fusion surgery. The goal is to prevent curve progression and cardiopulmonary compromise.

1. SCOLIOSIS
Dr.HARSHA NANDINI TALASILA
M.S Ortho

2. • The normal spine is straight in
the frontal plane.
• In sagittal plane it is composed
of 3 curves:
Cervical lordosis
Thoracic kyphosis
Lumbar lordosis

3. • Scoliosis means CROOKED
• Definition: lateral deviation of normal vertical line of the spine
• Lateral curvature of the spine also associated with rotation of the
vertebra.

4. • END VERTEBRA: the top and bottom vertebra that tilt maximally into
the concavity of the curve.
• APICAL VERTEBRA: central vertebra within a curve.typically the least
tilted,most rotated and most horizontally displaced vertebra within a
curve.
• NEUTRAL VERTEBRA : as we move from the apical vertebra, the first
distal vertebra that has no rotation.
• STABLE VERTEBRA: as we move from the apical vertebra, the first
distal vertebra which is bisected by the central sacral vertical line

6. • CURVE DIRECTION: right curves are the curves convex to right side.
• CURVE LOCATION :scoliotic curve is termed based on its apex.
Cervical thoracic: C7 or T1
Thoracic: T2
Thoracolumbar: T12 or L1
Lumbar L5 or S1

7. • CURVE MAGNITUDE : Cobb’s angle

9. Type Characteristics
Type I Lumbar curve is larger than the thoracic curve or nearly equal,
but the lumbar curve is less flexible on side bending
Type
II
A combined thoracic and lumbar curve and thoracic curve is
larger than or equal to the lumbar. On supine side-bending
radiographs, the lumbar curve is more flexible than the thoracic
curve
Type
III
Thoracic scoliosis with the lumbar curve not crossing the midline
Type
IV
Single long thoracic curve, with L4 tilted into the curve and L5
balanced over the pelvis
Type
V
A double structural thoracic curve. The first thoracic vertebra is
tilted into the concavity of the upper curve, which is structural.
An elevation of the left shoulder is a frequent finding. There is an
upper left thoracic rib hump and a lower right thoracic rib
prominence
KING’S CLASSIFICATION

11. RISSER SIGN: to asses the growth potential of the child. It
describes the ossification of the iliac apophysis. It ossifies from
lateral to medial.
• Grade 0: absent
• Grade 1: 0-25 %
• Grade 2 : 26 -50%
• Grade 3 : 51 – 75 %
• Grade 4: 76 – 100 %
• Grade 5 : fusion of apophysis to the ilium.
GRADE 0 and 1 : rapid curve progression
GRADE 4 : end of spinal growth in females
GRADE 5: end of spinal growth in males

12. Based on aetiology:
• IDIOPATHIC
• CONGENITAL
Based on associated conditions:
• Neuromuscular disorders
• Generalized diseases like neurofibromatosis, marfan’s syndrome,
bone dysplasia, tumours, post irradiation.

13. IDIOPATHIC SCOLIOSIS
• Infantile idiopathic scoliosis : birth to 3years
• Juvenile idiopathic scoliosis: 4years to 10years
• Adolescent idiopathic scoliosis: 10 years to skeletal maturity

14. CONGENITAL
• Due to failure in vertebra formation
• Failure in segmentation of involved vertebra

15. A.Anterior central defect. B. Incarcerated hemivertebra. C. Free hemivertebra. D.Wedge vertebra.
E.Multiple hemivertebrae.
DEFECTS IN FORMATION

16. DEFECTS IN SEGMENTATION
BLOCK VERTEBRA
Unilateral and unsegmented bar with
contralateral hemivertebra

17. INFANTILE IDIOPATHIC SCOLIOSIS
• Male :female 1:1 to 2:1
• CURVE TYPES: Left thoracic /right lumbar
• Associated findings :mental deficiency ,CDH, plagiocephaly, congenital
heart diseases.
• Risk of cardio pulmonary compromise high.
• Risk of curve progression <6months:LOW
>1YR:HIGH

18. • Most of curves are self limiting
• spontaneously resolve 70% to 90%
• when compensatory or secondary curve develops or when curve
measures more than 37 degree at the time of diagnosis, scoliosis is
progressive.
• Mehta differentiate resolving from progression of curves by
measurement of rib vertebral angle.

19. RIB VERTEBRAL ANGLE DIFFERENCE:<20 degrees :
resolving

20. TWO PHASE RADIOGRAPHIC APPEARANCE
• Phase 1: rib head on convex side does not overlap vertebral
body.
• Phase 2: rib head on convex side overlaps vertebral body.

21. TREATMENT
• RVAD less than 20 degree --observation with radiographic follow up
every 6 months.
• RVAD more than 20 degree: progressive scoliotic curve
1. Serial casting
2. Bracing
3. Pre op traction later fusion
4. Vertical Expandable Prosthetic Titanium Rib instrumentation with
out fusion(VEPTR)

22. CRANKSHAFT PHENOMENON
• Persistent anterior spinal growth in the presence of a posterior fusion
which can lead to recurrent and worsening spinal deformity.

23. JUVENILE IDIOPATHIC SCOLIOSIS
• AGE at presentation 4to 9 years
• Male:female <6yr:1:3
>6yr:1:6
• Right thoracic curve (R:L.6:1)
• Risk of cardio pulmonary compromise intermediate
• Risk of curve progression :67%
• Rate of curve progression at puberty : 6degrees/yr
malignant progression : 10 degrees/yr

24. Treatment
• RVAD less than 20degree :observation with radio graphs of every 4 to
6months.
• RVAD between 20 degrees 45 degrees: Milwaukee brace
• initially the brace worn 22of 24 hrly for atleast 1yr,after that
decreased gradually to night time only.

26. • If child younger than 8yrs: growing rod system without fusion
• If child is 9 to 10yrs : instrumentation and fusion should be a
combined anterior and posterior spinal fusion
• Intervertebral stapling

27. Adolescent idiopathic scoliosis
• This is most common type.
• Male:female:1:6
• Curve type: right thoracic(R:L,8:1)
• Risk of cardiopulmonary compromise low
• Rate of curve progression : 1to 2degrees/month

28. ADAMS FORWARD BENDING TEST

29. Factors related to progression adult idiopathic
scoliosis
• Girls >boys
• Premenarchal
• Risser sign of 0
• Double curves>single curves
• Thoracic curves>lumbar curves
• More severe curves

30. SURGICAL TREATMENT
Indications:
• In skeletally immature patient: Curves >40 degrees that are
progressive despite brace treatment.
• In skeletally mature patient : curves > 50 degrees

31. Treatment options

32. Posterior spinal instrumentation and posterior
fusion(commonly performed)

33. • Anterior spinal instrumentation and anterior fusion
• Anterior spinal fusion combined with posterior spinal instrumentation
and fusion.

34. ANTERIOR SPINAL FUSION COMBINED WITH POSTERIOR SPINAL
INSTRUMENTATION AND FUSION
• Used for curves that are result of failure of fusion.
• Best for treating single hemivertebra that have not resulted in a
large curve at the time of surgery.

35. REFRENCES
• CAMPBELL OPERATIVE ORTHOPAEDICS 13TH EDITION

36. THANKYOU