Scoliosis Scoliosis ... is defined as an appreciable lateral deviation in the normally straight vertical line of the spine. -Panjabi & White
Scoliosis The term Scoliosis is usually credited to HippocratesHe was the first to describe the disorder. Its derivation is from the Greek word Skolioswhich means twisted or crooked curvature 1stScoliosis Galen was the first to use the term (131-201)
A.D. Hippocrates is credited with the first description of this disorder. Guerin was the first to do Surgery for Scoliosis in 1839 1stScoliosis Wilhelm Konrad Roentgen was the first to x-ray in 1895.
Hibbs performed the first spinal fusion for Scoliosis in 1914. (Early 1900s, T.B. was widespreadspinal fusion was developed and used to control spinal involvement). Scoliosis Classification Non-structural Structural Scoliosis Classification
In an attempt to classify cases of scoliosis according to cause, it becomes apparent that there is an overlap between structural and nonstructural causes. A non-structural curve is described as a nonprogressive scoliosis, possessing symmetrical side bending movements on clinical and radiographic examination. The curve is generally mild and is found in the lumbar and thoracolumbar regions. The major cause of these curves is the short leg, and is quite commonly found in practice. Scoliosis Classification
The Structural scoliosis deformity is characterized as being more likely to progress, having a fixed vertebral body rotation, and a prominence viewed in the thoracic or lumbar region. This prominence, referred to as a rib hump or lumbar prominence, persists through side bending, forward flexing, and radiographic examinations. Non-structural Scoliosis (non-progressive)
Postural Mildfound in Lumbar and thoracolumbar regions. LLIMajor cause found in practice. Sciatic Inflammatory Important!!! The importance of Non-structural Scoliosis lies in its ability to evolve into a structural
deformity. Once the curve takes on structural manifestation, it is more likely to progress and have a poorer prognostic outlook for the patient. Prime example of this altered growth pattern is explained by the HeuterVolkman Law: Suggests that altered end plates with pressure via the scoliosis, may retard normal vertebral body development resulting in body wedging. Structural Scoliosis Idiopathic (85-90%)Skeletally immature patients (boys <18 &
girls < 16), the most common type of scoliosis is caused by unknown factors. Infantile: 0 - 3 years; Juvenile: 3 - 10 years; Adolescent: 10 to S.M. (B = 18 & G = 16) Congenital Neuromuscular Neurofibromatosis a familial condition characterized by
developmental changes in the nervous system, muscles, bones, and skin, and marked by the formation of neurofibromas over the entire body associated with areas of pigmentation. Structural Scoliosis Traumatic Metabolic
Family Hx: Determine genetic link and seek out siblings due to increased risk. Ruth Wynne - Davies reports siblings of scoliotic patients have a 40% greater chance/risk of developing spinal deformities as compared to the general population. Structural Scoliosis
As the magnitude of the curvature increases, the lateral deformity increases as welland so does the accompanying rotation. The Rotation of the vertebral column promotes prominence of the rib heads and TVPs. These findings are fundamental for early detection. Complications of Scoliosis
Pain Radiation induced abnormalities Psychological How do we find it? School screeningsABCs (40 % of the curves detected on school screenings may be attributed to leg length inequality during adolescence).
Rib Hump: ( >0.8 cm in T region) Lumbar Prominence: (> 0.5 cm in L region) Scoliometer (> 5 ATR) Radiographic assessments School Screenings Torell et.al demonstrated success in performing school screening and effectively reducing the number of children
who progress to a protocol indicating surgical stabilization. They targeted early detection and treatment of idiopathic scoliosis. 3 fold increase in number of patients treated for Scoliosis, the number requiring surgery declined! School Screenings
3 methods: ABCs of school screenings! A) Have the patient to flex forward while standing and to observe the horizon created by the thoracic and lumbar regionhowever, this method is extremely subjective and offers no quantitative findings. School Screenings B) Utilize the same forward flexion; however, this time, the rib hump and lumbar prominence are
measured with a ruler. A measurement of 5 to 8 mm is significant (5mm in lumbar region & 8 mm in the thoracic region). Spine 7 (6) : 556, 1982 Illustration on page 311: Low back pain by Cox. In addition to the rib hump and lumbar prominence, consider the height of the shoulder, the scapula, the iliac crest and the axillary gaps. The purpose of measuring for an increase in the Rib/Lumbar regions is to reduce the
large number of insignificant and false positive curves. School Screenings C) Use a Scoliometerdeveloped by William Bunnel. The Scoliometer is placed on the dorsal region of the forward bending patient in the T and L regionsat the apices of the curves. Minimal angle of trunk (ATR) is 5. At 5 of ATR, you should refer the student for possible radiographic assessment. However, to avoid further radiation, use the
Scoliometer to monitor progression. Lower than 5Observe and re-evaluate in 6 months (continue with Chiropractic care) Radiographic assessment Radiographic assessment Valuable Dx tool To help assist in etiology and Dx; curve magnitude;
skeletal age; wedging; Rotation. P - A view is betterfor reduction of radiation to visceral organs and breast tissue. Use rare earth screens to help minimize radiation in adolescent patients Most Accurate Skeletal age is more important than Chronological age:
May vary months or yearsvery important for prognosis A left view of the wrist is obtained to determine skeletal age. (Left wrist view comparison with standard atlas of Greulich and Pyle) Risser Sign Use the A - P or P - A view to evaluate the Risser sign. A secondary ring apophysis (growth plate) develops
over the top of each iliac crest. The apophysis will appear at the most lateral aspect of the crest near the A.S.I.S. and migrate medially toward the sacral ala. As the apophysis migrates, it is graded from 1 to 4 for females, and 1 to 5 for males. Risser Sign It can be used as a prognostic indicator. A child with a low grade Risser sign (I.e., 1) and a scoliotic deformity of significant magnitude has a poorer
prognosis than one who has a high grade Risser sign (I.e., 4) and equal curve magnitude. Low grade RisserMore growth potential and associated curve progression. High grade RisserLess growth potential and less likely to demonstrate curve progression Risser sign4 for females, 5 for males.
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