my lecture scoliosis

8/7/2019 my lecture scoliosis

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SPINAL DEFORMITIES

BY ,

NEHA GAGGAR (MPT)


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SPINAL DEFORMITY

DEFINTION :

any abnormality of the formation , alignment , or shape of the

vertebral column .

TYPES :

1. Frontal plane

scoliosis2. Sagital plane

forward head

kyphosis

exaggerated lordosis

flat back

However SCOLIOSIS have multiplanar component : frontal

sagital

torsional


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SCOLIOSIS

DEFINITION :

Appreciable lateral deviation (>10 degrees) in the normally straight

vertical line of spine.

ETIOLOGY :

Genetic

Disorders of bone , muscle, disc

Developmental growth abnormalities

Central nervous system causes


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CLASSIFICATION

SCOLIOSIS

C

STRUCTURAL NONSTRUCTURAL

A.Idiopathic A.Postural

Infantile(0-3yrs) B.Compensatory

juvenile (4-9yrs) C.Sciatic Adolescent (10-20 yrs)

B.Congenital

C.Neuromuscular


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GRADES OF SCOLIOSIS

Grade I mild postural scoliosis

Grade II structural scoliosis with curve < 40 degrees

Grade III structural scoliosis with curve > 40 degrees


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CURVE PATTERNS

1.Cervical curve : apex between C1 C6

2.Cervicothoracic curve : apex is at C7, T1

3.Single major thoracic curve : Apex is between T2 T11

4.Single major high thoracic curve : Apex from T3 with the curve

extending from C7 or T1 to T4 or T55.Single major lumbar curve: Apex between L1-L2 and L4

6.Single major thoracolumbar curve : Apex is at T12 or L1

7.Combined thoracic & lumbar curves (double major curves) :

Symmetrical double major curves

8.Double major thoracic curve :Upper thoracic from T1 to T5 or T6 and convex to the left


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SCOLIOTIC CURVES

1. Compensatory curve due to primary curve

2. Compensatory curve due to deformities in

other parts of the body3. Rotational element


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EVALUATION

I. INSPECTION

A.OBSERVATION

1.level of ear & contour of neck

2. shoulder level

3. scapular level

4. position of the arms and the waist line

5. back

6. thorax

concave : ribs crowded & flattened

convex : ribs apart & buldge backwards

7. hips & PSIS8. pelvis : concave : forward rotation

9.knee

10.feet


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EVALUATION CNTD...

B. ADAMS TEST

II. EXAMINATION

1. Range of motion

2.scoliometer


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EVALUATION CNTD...

3.Cobb angle measurement

: The Cobb method is used to measure the degree of scoliosison the posteroanterior radiograph .

STEP 1 : the apical vertebra is first identified; this is

the most likely displaced and rotated vertebra with

the least tilted end plate.

STEP 2 : The end/transitional vertebra are then

identified through the curve above and below.

The end vertebra are the most superior and inferior

vertebra which are least displaced and rotated and

have the maximally tilted end plate.

STEP 3 : A line is drawn along the superior end plate

of the superior end vertebra and a second line drawn

along the inferior end plate of the inferior end vertebra.

The angle between these two lines (or lines drawn

perpendicular to them) is measured as the Cobb angle.


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EVALUATION CNTD...

4. To check vertebral rotation :

Nash and moe method,

Look at the pedicles

If they are equidistant from the sides of the vertebral bodies ,

no vertebral rotation (0 rotation)

Grade 4 is in which the pedicle is past the center of thevertebral body.

5. Skin marker


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EVALUATION CNTD...

6.Rib Mehtas angle

(Difference at the apical rib) is of prognostic value.

The RVA difference (RVAD) is the difference between the values of the RVAs on the

concave and convex sides of the curve [apical vertebra].

If the convex apical rib head does not overlap the apical vertebral body, a curve with an

initial RVAD of 20 or more is considered progressive.One line perpendicular to the apical vertebral endplate and another from the mid neck to

the mid head of the corresponding rib.

7.MRI8.CT Myelography


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MANAGEMENT

OBSERVATION

SURGERY

BRACING


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PREVENTIVE ROLE

early detection

screening programme for all school children of

age between 10-14 yrs

education of parents and teaching them simple

observational technique


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BASIC PRINCIPLES OF CORRECTION

1. ACTIVE CORRECTION :

self corrective postural activities

2. PASSIVE CORRECTION :Unequal hanging

Axial traction given by 2 therapists

3. MAINTENANCE OF CORRECTION :

Education of patient

Spinal bracing


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MANAGEMENT FOR GRADE I

Re-education of bad posture

monitoring after every 6 months

regimen includes:

general body relaxation

re-education of correct posture

passive correction

repeated session of maintenance of corrected posture

general free mobility exercises

strengthening spinal extensors, abdominals

deep breathing ex

balance ex stretching of concave side

avoiding activities prone to produce the deformity


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MANAGEMENT FOR GRADE II

MILWAUKEE BRACE

Aka Cervicothoraciclumbosacral orthotic (CTLSO brace)

Adjustable ht, can grow with the patientWorn 23 hrs/day

Contains pelvic attachment, thoracic pads,

and chin support

Primary goal = stop progression of

scoliosis

Very effective if treatment plan is followed


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BOSTON BRACE

Aka Low Profile Thoracolumbarsacral orthotic (TLSO)

Primarily used for lower thoracic,

thoracolumbar , & lumbar curves

Still widely used, due to better

patient acceptance than Milwaukee

Brace


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EXERCISE THERAPY

Goals = Improve ROMEspecially in direction of convexity

Reduce contractural change of soft tissues on

concave side

Done through:Improve strength, endurance, & postural

control of muscles on convex side

Identify & correct vestibular and/or

proprioceptive imbalance/deficiency

Improve balance & coordinationNormalize weight bearing in lower

extremities & spine


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Specific Exercises:

Stretch concave side = balance ball, hanging from

bar, leaning against wall

Strengthen convex side = active exercise

Strengthen trunk muscles

Rotary torso exercises to left (right thoracic curve)

Proprioceptive training

Heel lift (up to 5 mm) goal is to balance weight

bearing for CNS re-education, re-evaluate every 6

weeks


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Exercises to restore cervical lordosis

Work with Exercise Ball proprioceptive control

Sleep posture lying on side with pillow under

ribs

To correct pelvic unleveling (ex. elevated Rt.

Ilium)

Strengthen: Lt. QL, Lt. hip adductors, Rt. G

Med

Stretch: Rt. QL, Rt. hip adductors, Lt. G Med

Breathing exercises maximize & normalize

chest expansion


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MANAGEMENT FOR GRADE III

Surgery is the treatment of choice

TRACTION

NONSKELETAL SKELETAL

1.Combination of

intermittent and

continuous

2. Superimposition of

both

3. Traction of

gravitational

1.Halopelvic

2. halofemoral


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INDICATIONS FOR SURGERY

1. Cord compression

2. Rapid progressive curve

3. Severe pain

4. Respiratory impairment

5. Cosmetic


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AIMS OF SURGERY

1. Restore the symmetry of trunk as much as possible

2. Straighten the thoracic curve to stop decrease in

pulmonary function


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PRINCIPLES OF SURGERY

I . CORRECTION OF CURVE :

1. turnbuckle cast techniques

2. distraction technique

3. lessening of the curve

II. MAINTENANCE OF CORRECTION ACHIEVED1. spinal fusion

2. spinal instrumentation

harringtons instrumentation

segmental spinal instrumentation

Dwyers instrumentation

Zieko instrumentation


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PREOPERATIVE PHYSIOTHERAPY

measurements

assessment of pulmonary function

muscle charting

detailed neurological examination gait analysis and functional status

postural guidance

spinal stretching and mobility


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POSTOPERATIVE PHYSIOTHERAPY

FIRST 2 DAYS

Respiratory status

Ankle toe movements

upper extremity mobility

Passive movts to lower limb

turning every 2 hrly

3 RD & 4 TH DAY

Active movts for lower limb

measurement of curve

AFTER 5 DAYS

Guidance in rolling , sitting , standing

sitting

chair sitting

standing and walking


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my lecture scoliosis