This document discusses spinal deformities including types, causes, examination, and treatment. There are three main types of deformities: dynamic, rigid, and a combination. Causes can be due to conditions like tuberculosis, trauma, or genetic syndromes. Examination involves assessing for scoliosis, kyphosis, and other abnormalities. Treatment depends on severity but may include exercises, bracing, or surgery to correct deformities through procedures like osteotomies or spinal fusion.

1. DEFORMITIES OF SPINE
General overview
Dr RAJESH OJHA
Mbbs MS ortho
kgmc Lucknow

2. Types of deformities
1 Dynamic where it is possible to correct the deformity actively
or passively
This is usually related to joints
2 Rigid or fixed where deformity can not be corrected without
some syrgery,this is
Usually due to change in the shape of bones or joint fused in
deformed and awakword conditions
3 combination where partial correction possible by active or
passive means
(DE-FOR′MĬT-Ē) DEFORMITAS, UGLINESS, DEFORMITY] ALTERATION IN
OR DISTORTION OF THE NATURAL FORM OF A PART, ORGAN, OR THE
ENTIRE BODY. IT MAY BE ACQUIRED OR CONGENITAL. IF PRESENT
AFTER INJURY, DEFORMITY USUALLY IMPLIES THE PRESENCE OF
BONE FRACTURE, BONE DISLOCATION, OR BOTH

4. Compensatory scoliosis is
slightly different from other
types of scoliosis as the
spinal curve seems to
disappear when the patient
is sat down. This is because
compensatory scoliosis is
usually caused by a pelvic
tilt caused by the
contracture of the hip, or
because one of the patient's
legs is shorter than the other
Cobbs angle

6. Examination of spine
Look for any obvious swellings or surgical scars. Assess for deformity: scoliosis, kyphosis, loss of lumbar
lordosis or hyperlordosis of the lumbar spine. Look for shoulder asymmetry and pelvic tilt. Observe the
patient walking to assess for any abnormalities of gait.

7. • Best examined
from behind,
notice any
curvature Rib
hump appear on
bending
• Any pelvic
obliquityto be
seen

8. KYPHOSIS
SCOLIOSIS
Kyphoscoliosis
LORDOSIS
SPODYLOLYSTHESIS

9. Spondylolisthesis A spinal disorder in which a
bone (vertebra) slips forward onto the bone
below it.

10. • Iidiopathic no apparent reason, neurofibromatosis,
arthogryposis multiplex congenita
• Neuromuscular Post polio affection of spinal or lower
limb muscles ,Musculer dystrophies Duchenne and Becker
type couses correctible lordosis due to muscle imbalance
• Trauma vertebral fracture and malunion
• InfectionTuberculosis of spine leading to collapse and
deformity
• Congenital drug taken during pregnency
like steroids ,anticancer sedatives is known to
affect differentiation of cell of embryo
• Biological Rubella and cytomegalic virus
• Metabolic disorders Marphan syndrome

11. Couse of kyphosis varies with age
Commonest Couse in infant is congenital fused
vertebrae,spina bifida
In a child going to school may be caused by poor posture or weight of
school bag
tuberculosis of spine is the cause if angular kyphosis
develops associated with poor health, and xray picture
showing changes suggestive of tb
congenital anguler kyphosis is associated with fused
vertebrae or partial agenesis

12. Some known and recognized disease/syndromes that are associated with
spinal deformities
 Spina bifida
 Arthrogryposis Multiplex Congenita
 Congenital fused vertebrae
 Sprengel shoulder
 Klippel flail syndrome
 Sherman’s adolescent kyphosis
 Marfan syndrome
 Morquio syndrome
 Idiopathic adolescent scoliosis
 Kyphoscoliosis associated with Neurofibromatosis
 Senile kyphosis associated with osteoporosis
 Sequel of spinal trauma
 Sequel of Post polio residual paralysis
 Pott’s spine(tuberculosis)
 Ankylosing spondylitis

14. • COUSE OF ANGULER KYPHOSIS
TRAUMA
TUMOR
TUBERCULOSIS
CONGENITAL DEFECTS

16. A wedge fracture is a vertebral
compression fracture occurring
anteriorly or laterally. Viewed,
the affected vertebra resembles
a wedge. These fractures are
more commonly found in the
thoracic spine, which is rather
rigid displaying only a few
degrees of flexion and
extension.
Angular kyphosis after
fracture vertebra

17. Affection or collapse of vertebral
body benign malignant or
metastatic can Couse spinal
deformity

18. is when a baby's backbone (spine)
arch does not fully form during
pregnancy. The baby is born with a
small gap in the bones of the spine.
Spina bifida occulta is common and
happens in about 1 out of 10 people.
Usually, spina bifida occulta causes no
health problems.
Usually a tuft of hair or hyperpigmented
area over spine is indicative
In more sever case a menigiocele or
mylocele is present

19. Marfan syndrome

21. Morquio syndrome is a rare genetic
condition that affects a child's bones
and spine, organs, and physical
abilities. Children with this condition are
missing or don't produce enough of the
enzymes that break down sugar chains
naturally produced in the body.

22. Arthrogryposis multiplex congenita (AMC) refers to the
development of multiple joint contractures affecting
two or more areas of the body prior to birth

23. a condition affecting the development of the bones in the spine. People
with KFS are born with abnormal fusion of at least two spinal bones
(vertebrae) in the neck. Common features may include a short neck, low
hairline at the back of the head, and restricted movement of the upper spine

24. is a rare congenital disorder in
which the shoulder blade (scapula)
is too high on one side of the
body. The affected abnormal
shoulder blade is also abnormally
connected to the spine, often
restricting movement of the shoulder.

25. Scheuermann's disease adolescent
kyphosis describes a condition where
the vertebrae grow unevenly with
respect to the sagittal plane; that is, the
posterior angle is often greater than the
anterior. This uneven growth results in the
signature "wedging" shape of the
vertebrae, causing kyphosis.

26. •Scheuermann's Kyphosis is a rigid form of spinal kyphosis caused by
anterior wedging of >5 degrees across three consecutive vertebrae,
osteonecrosis of anterior apophyseal ring
•herniation of disc material leading to loss of anterior disc height
•relative osteoporosis leading to compression deformity
•altered biomechanics leading to anterior wedging and subsequent
growth arrest
•most widely accepted theory suggests that the kyphosis and
vertebral wedging are caused by a developmental error in collagen
aggregation which results in an abnormal end plate
•most commonly in the thoracic spine.
•Diagnosis is made with standard and hyperextension lateral
radiographs of the thoracic spine.
•Treatment can be observation or surgical management depending on
the severity of kyphosis, presence of neurological deficits, and/or
persistent and progressive pain.

28. Schmorl nodes represent a herniation or an
extrusion of the intervertebral disc nuclear material
through the vertebral body endplate, with
displacement of this material into the adjacent vertebral
body [2]. The herniated tissue may form a defect in the
upper or lower surface of the involved vertebra.

29. Rounded kyphosis is excessive
forward curve of spine as a result
of collapse or shortening of
anterior part of multiple vertebrae

31. Commonest
Couse is senile
kyphosis
associated
with old age

33. Kyphosis associated with Ankylosing
spondylitis is an inflammatory disease that,
over time, can cause some of the small bones in
your spine (vertebrae) to fuse. This fusing makes
the spine less flexible and can result in a
hunched-forward posture

34. affecting
spine Ankylosing spondylitis
(bamboo spine)

35. scoliosis, even in
children with
neurofibromatosis, is
quite similar to
“typical” scoliosis,
called adolescent
idiopathic scoliosis.

36. Lordosis is the term used in
relation to lumber spine and
mostly a compensatory to
excessive dorsal spine
affections

37. Lordosis is an exaggerated inward curve
of the spine that typically affects the
lower back, a condition called lumbar
lordosis,it is reverse of kyphosis
Loss of lumber lordosis is common xray
finding in case of low back pain due to
spasm

38. Duchenne and Becker
types of muscular
dystrophy

39. Scoliosis is a sideways curvature of
the spine
that most often is
diagnosed in adolescents
When not otherwise mentioned
scolosis refers to idiopathic adolescent
scoliosis
Term Kyphoscoliosis used for
combination of kyphosis as well as
scoliosis.
This always has a rotational element

43. Treatment of spinal deformities
Physiotherapy stretching
Permanent Bracing by plaster
Removable brace
Surgery

44. In older adults, if osteoporosis is the underlying
cause of the deformity, we may treat it
with calcium, hormone replacement therapy, or
weight-bearing exercises. Bracing is another
nonsurgical option for adults. It will not change the
position of the spine, but it may ease pressure and
pain.

45. Only kyphosis and scoliosis which are of
significant severity need to be treated,
Specific conditions require specialized
approach
 Exercise and postural correction for mild
 Molded or universal brace
 Surgery

46. Primitive equipment’s for corrective
stretching

48. 1) Core Strength: Your core muscles include
your abdominal muscles, back muscles and
muscles around the pelvis. These muscles are
designed to protect the spine by creating a sturdy
rod that limits excessive movement in any
direction.
2) Proprioception: Proprioception is the sense
of the body in space regarding position, motion,
and equilibrium
3) Posture: Your spine is strong and stable when
you practice healthy posture. But when you stoop
or slouch, your muscles and ligaments struggle to
keep your body upright and balanced. Poor
posture can stress or pull muscles, which may
Exercise and postural correction

53. 1. By plaster or removable Bracing to maintain
the affected part in corrected position
Milvaukee plaster

56. Surgery for deformity correction
Any deformity anywhere in body need to be corrected
permanently or to great extent by means of
soft tissue release erasing muscles or ligaments to achieve
correction
osteotomy cutting the deformed bone to achieve correction
Fusion of joint or orthrodesis to rtain it in corrected position
After achieving desired correction there is usually need to retain it
externally by means of calipers or braces, or internally by
appropriate implants

57. Surgical correction of the misplaced
vertebra is required when the bone
has slipped so far down that your
spine doesn’t respond to nonsurgical
therapies. Surgery is also required if
the bones of your spine are pressing
on your nerves

58. Deformity correction by soft
tissue release means making
the tight muscles or ligament
freed from bone attachments
to achieve correction or
lengthen them by making
appropriate cuts

59. Arthrodesis is a procedure to make two bones fuse together to
eliminate joint aimed at the purpose of correction of deformity,
relief from pain and provide stability. This involves decortication
to denude the vascular part of bone, removal of intervening
cartilage and stabilizing it with plaster cast, plates screws or rods
till boney union is achieved. It often require putting Bone
chips/grafts to ensure union
 Autograft
 Allografts. ...
 Xenograft. ...

63. Surgery can usually correct the appearance of the
back and may help to relieve pain but it carries quite a
high risk of complications. Surgery is only
recommended for more severe cases of kyphosis,
where it's felt the potential benefits of surgery outweigh
the risks.
One such is spinal osteotomy for severe
case of ankylosing spondylitis

64. Vertebroplasty is a procedure
in which a special cement is
injected into a fractured
vertebra — with the goal of
relieving your spinal pain and
restoring your mobility.
Bone cement Polymethyl
methacrylate (PMMA), is commonly
known as bone cement, and is widely used for
implant fixation in various Orthopaedic and
trauma surgery

65. Kyphoplasty: a minimally
invasive procedure used
to treat vertebral
compression fractures by
inflating a balloon to restore
bone height then injecting
bone cement into the
vertebral body
Advantage is bone cement remains
contained ,no spill out

68. Spondylolisthesis is a spinal
condition that causes lower
back pain. It occurs when one
of your vertebrae, the bones
of your spine, slips out of
place onto the vertebra below
it. Most of the time,
nonsurgical treatment can
relieve your symptoms. If you
have severe
spondylolisthesis, surgery is
successful in most cases

71. The pars interarticularis or
simply pars is the part of a
vertebra located between the
superior and inferior articular
processes. In the axial plane
the pars in located at the
junction of the pedicle and
lamina. In the oblique lumbar
radiograph, the neck of the
Scottie dog represents the
pars.

74. Spondylolisthesis Treatment
•Medications. Pain medications, such as
acetaminophen, and/or NSAID's (e.g.
ibuprofen, COX-2 inhibitors) or oral steroids
to reduce inflammation in the area. ...
•Heat and/or ice application. ...
•Physical Therapy. ...
•Manual manipulation. ...
•Epidural steroid Injections. ...
•Spondylolisthesis Surgery

75. Surgical correction of
the misplaced
vertebra is required
when the bone has
slipped so far down
that your spine
doesn’t respond to
nonsurgical therapies.
Surgery is also
required if the bones
of your spine are
pressing on your
nerves

84. Scoliosis MCQ