Professor of OrthopaedicsProfessor of Orthopaedics

1/15/2011 ١Professor Freih Abu hassan -University of Jordan

Sagittal plane deformity in the thoracic orSagittal plane deformity in the thoracic or thoracolumbar spine

Thoracic Spine Kyphosis : 25 - 45 degrees

Typesyp1- Mobile2 Fixed2- Fixed3-Angular

1/15/2011 ٢Professor Freih Abu hassan -University of Jordan

1 Mobile Kyphosis1- Mobile KyphosisC t bl b th ti t’ l bCorrectable by the patient’s own muscles or by the surgeon

A PosturalA- PosturalB- Muscle weaknessB Muscle weaknessC- Compensatory to L. lordosis

1/15/2011 ٣Professor Freih Abu hassan -University of Jordan

Associated withAssociated with1-Flat feet2 f i i2-Women after child birth3- Obesity3 Obes ty

C.P

Painless, Correctable, , ,

Long curve, N. X-ray1/15/2011 ٤Professor Freih Abu hassan -

University of Jordan

T t tTreatment

Posture trainingPosture training

Exercises

Weight reductionWeight reduction1/15/2011 ٥Professor Freih Abu hassan -

University of Jordan

* Muscle dystrophy* Muscle dystrophy* Polio.(Lumbar lordosis and Thoracic kyphosis)Thoracic kyphosis)

1/15/2011 ٦Professor Freih Abu hassan -University of Jordan

* Gross hip deformity e.g hip dislocation ,fi d fl i hi d ffixed flextion hip def.

lumbar lordosis Thoracic kyphosisyp

1/15/2011 ٧Professor Freih Abu hassan -University of Jordan

Compensatory to L. lordosis1/15/2011 ٨Professor Freih Abu hassan -

University of Jordan

2- Fixed Kyphosis2- Fixed KyphosisNot correctable by the patient’s own muscles orNot correctable by the patient s own muscles or by the surgeon

Types1 S h ’ di1- Scheuermann’s disease2- A. Spondylitisp y3- Senile kyphosis4 Bone dysplasia4- Bone dysplasia5- with Scoliosis

1/15/2011 ٩Professor Freih Abu hassan -University of Jordan

Scheuermann’s dis

Senile kyphosis

1/15/2011 ١٠Professor Freih Abu hassan -University of Jordan

3-Angular Kyphosis3-Angular Kyphosis1- Cong.1 Cong.2- T.B3 V b l b d ll3- Vertebral body collapse= Trauma, Tumour,= infection

C l ’= Calve’s5- Deficient post bony elementsp y= post laminectomy, Spina bifida

1/15/2011 ١١Professor Freih Abu hassan -University of Jordan

1/15/2011 ١٢Professor Freih Abu hassan -University of Jordan

T BT.B

1/15/2011 ١٣Professor Freih Abu hassan -University of Jordan

Progressivek hkyphus

T.B

Lumbar abscess ١٤

Coin test1/15/2011 Professor Freih Abu hassan -

University of Jordan

Calve’sCalve s

1/15/2011 ١٥Professor Freih Abu hassan -University of Jordan

Kyphoscoliosis

1/15/2011 ١٦Professor Freih Abu hassan -University of Jordan

Age related KyphosisAge related Kyphosis1- Child Cong1 Child Cong.,2- Adolescent Postural,,

Scheuermann’s disease3- Young adult A.S4 Elderly Senile Path #4- Elderly Senile, Path. #,

Paget’s.Paget s.5- All age group T.B

1/15/2011 ١٧Professor Freih Abu hassan -University of Jordan

KYPHUS

1/15/2011 ١٨Professor Freih Abu hassan -University of Jordan

Scheuermann’s diseaseScheuermann s diseaseCauses

1- Unknown

Causes1 Unknown2-Osteochondritis (irregular ossification of epiphyseal plates)(irregular ossification of epiphyseal plates)

3- Undue strain on the ant. ti f th t b l b diportion of the vertebral bodies

4-Traumatic infarction of the epi. plates5-Vertebral osteoporosis and the discsherniate in the fragile bonee e e g e bo e1/15/2011 ١٩Professor Freih Abu hassan -

University of Jordan

= Starts at puberty= Starts at puberty= > in females > in females= Round shoulders= Back pain + fatigue

1/15/2011 ٢٠Professor Freih Abu hassan -University of Jordan

1/15/2011 ٢١Professor Freih Abu hassan -University of Jordan

O/EP= Poor posture

= Smooth kyphosis= Smooth kyphosis= Lumbar lordosis= Non correctable= Full ROM

Ti ht h t i !!!????= Tight hamstrings!!!????

1/15/2011 ٢٢Professor Freih Abu hassan -University of Jordan

X ra sX-rays* Wedging ant > 5 degree of eachWedging ant. > 5 degree of each

vertebra D6 - D10* Contain small translucent areas

(Schmorl’s nodes)(Schmorl’s nodes)* Fragmented ant. epiphyseal platesg p p y p

> 3 Vertebrae* A 40* Angle > 40

1/15/2011 ٢٣Professor Freih Abu hassan -University of Jordan

1/15/2011 ٢٤Professor Freih Abu hassan -University of Jordan

D DxD.Dx1- Postural: Painless, Correctable, , ,

Long curve, N. X-ray2 T B2-T.B= Angular kyphos Angular kyphos= X-ray : = destruction at least two

adjacent vertebrae with= narrowing of the disc += narrowing of the disc + = paravertebral abscessp ve eb bscess

1/15/2011 ٢٥Professor Freih Abu hassan -University of Jordan

R/R/= 40 60 Degree= 40-60 Degree Postural trainings gStrengthening exercises.

= 60 degree in young child 60 degree in young child Corrective cast for 6 m followed by Milwaukee brace until remodelling of the vertebrae.vertebrae.

1/15/2011 ٢٦Professor Freih Abu hassan -University of Jordan

R/R/Older adolescent and adult 60= Older adolescent and adult 60 degreedegree

* If painful , > 60 degree, or impending paresis.1 ant release and m ltiple disc e cision1- ant. release and multiple disc excision2- traction for 2 weeks3- Post fusion

1/15/2011 ٢٧Professor Freih Abu hassan -University of Jordan

1- Cosmesis2- Stop progression3- Alleviate pain4- Prevent pain in the future

1/15/2011 ٢٨Professor Freih Abu hassan -University of Jordan

Scheuermann’s disease

1/15/2011 ٢٩Professor Freih Abu hassan -University of Jordan

Types1 F il f f i f b l1- Failure of formation of vertebral

body 20% paralysisbody. 20% paralysis2-Failure of segmentation

Very slow progression, no risk of paralysisparalysis

3-Combination1/15/2011 ٣٠Professor Freih Abu hassan -

University of Jordan

1/15/2011 ٣١Professor Freih Abu hassan -University of Jordan

1/15/2011 ٣٢Professor Freih Abu hassan -University of Jordan

1/15/2011 ٣٣Professor Freih Abu hassan -University of Jordan

1/15/2011 ٣٤Professor Freih Abu hassan -University of Jordan

1/15/2011 ٣٥Professor Freih Abu hassan -University of Jordan

Type 1P t f i ith t i t t tiPost fusion without instrumentation at the age of 3 years.at the age of 3 years.If seen late ant. strut graft and after 2-4 weeks post fusion

Type 3 Ant.& Post fusion1/15/2011 ٣٦Professor Freih Abu hassan -

University of Jordan

1- Senile2- Senile osteoporosis3- Paget’s4- Pathological #

1/15/2011 ٣٧Professor Freih Abu hassan -University of Jordan

S il k h iSenile kyphosis= More in males= More in males.= Multiple discs degeneration causing

narrowing followed by slight wedging= little pain unless development of little pain unless development of

Facet O.A.

1/15/2011 ٣٨Professor Freih Abu hassan -University of Jordan

Senile OsteoporosisU ll i hi f l= Usually in thin females.

= Wide spread osteoporosis Wide spread osteoporosis= Code fish spine= Pain is common due to fracturesOr due to compensatory lumbarOr due to compensatory lumbar

lordosis or O.A

1/15/2011 ٣٩Professor Freih Abu hassan -University of Jordan

R/= ANTI OSTEOPOROSIS R/

STICK= STICK= ANALGESIA= ANALGESIA

1/15/2011 ٤٠Professor Freih Abu hassan -University of Jordan

1/15/2011 ٤١Professor Freih Abu hassan -University of Jordan

Paget’s kyphosis= due to bone softening= associated criteria of paget’s= associated criteria of paget s

(thick bent bones)(thick bent bones)= large vertebra with coarse

trabeculation

1/15/2011 ٤٢Professor Freih Abu hassan -University of Jordan

Pathological # kyphosisT= Trauma

= Metastasis Metastasis

R/*With neurology Surgery*With neurology - Surgery*No neurology Radio/ +Brace.gy

1/15/2011 ٤٣Professor Freih Abu hassan -University of Jordan

= Cong.g= Neuromuscular= Post surgeryg y

1/15/2011 ٤٤Professor Freih Abu hassan -University of Jordan

1/15/2011 ٤٥Professor Freih Abu hassan -University of Jordan