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SCOLIOSIS

MUHAMMED KOCABIYIK PHYSICAL MEDICINE & REHABILITATION IV. CLASS V. GROUP

Scoliosis ? from Greek: skolisis meaning from skolios, "crooked twisted) a medical condition in which a person's spine is curved from side to side. Although it is a complex threedimensional deformity, on an x-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line.

Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosis is a curve seen from the side in which the spine is bent forward. Lordosis is a curve seen from the side in which the spine is bent backward. People with scoliosis develop additional curves to either side, and the bones of the spine twist on each other like a corkscrew.

WHAT CAUSES SCOLIOSIS?


In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. Infantile Idiopathic Scoliosis - if the
person is less than 3 years old Juvenile Idiopathic Scoliosis - develops between 3 and 10 years of age/onset of puberty Adolescent Idiopathic Scoliosis - over 10 years old or postpuberty ; most common

There are 3 other main types of scoliosis: Functional : the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back. Neuromuscular : there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely, or they fail to separate from each other.

This type of scoliosis develops in people with other disorders including birth defects, muscular dystrophy, cerebral palsy, or Marfan's disease. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.

Degenerative: Unlike the other forms of scoliosis

that are found in children and teens, degenerative scoliosis occurs in older adults. Caused by changes in the spine due to arthritis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. Others: There are other potential causes of scoliosis, including spine tumors such as osteoid osteoma. This is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce the amount of pressure applied to the tumor.

WHAT ARE THE SYMPTOMS OF SCOLIOSIS?


Most common symptom - abnormal curve of the

spine.

Scoliosis may cause the head to appear off center or one hip or shoulder to be higher than the opposite side. If more severe, it can make it more difficult for the heart and lungs to work properly - cause shortness of breath and chest pain In most cases, scoliosis is not painful, but there are certain types of scoliosis than can cause back pain.

HOW IS SCOLIOSIS DIAGNOSED?


Can use a medical and family history, physical exam, and tests when checking a person for scoliosis. An x ray of the spine can help the decide if a person has scoliosis. The x ray lets the measure the curve in degrees (such as 25 degrees) and see its location, shape, and pattern. Also may request an MRI scan.

THE COBB METHOD


Choose the most tilted vertabrae above and below the apex of the curve. Draw a line perpendicular to that vertabrae. The angle created between these intersecting lines is the Cobb angle.

TESTS

Adams Bend Test

HOW IS SCOLIOSIS TREATED?


Treatment for scoliosis is based on: 1. The person's age 2. How much more he or she is likely to grow 3. The degree and pattern of the curve 4. The type of scoliosis

There are main categories of treatment:

HOW IS SCOLIOSIS TREATED?

observation, physical therapy, bracing, and surgery Functional scoliosis is caused by an

abnormality elsewhere in the body. this type of scoliosis is treated by treating that abnormality, such as a difference in leg length there is no direct treatment of the spine because the spine is normal in these people

Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine. have the greatest chance for getting worse. observation and bracing do not normally work well Majority will eventually need surgery to stop the curve from getting worse.

Idiopathic scoliosis - based on the age when it develops In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective Juvenile idiopathic scoliosis - has the highest risk for getting worse of all of the idiopathic types of scoliosis.

Bracing can be tried early if the curve

is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.

Adolescent idiopathic scoliosis - is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve stays

below 25 degrees, no other treatment is needed. If the curve is between 25-40 degrees, a brace

may be recommended. If the curve is greater than 40 degrees, then surgery may be recommended.

Surgery: 1. to correct a curve or stop it from getting worse when the person is still growing 2. the curve is more than 45 degrees & the curve is getting worse. 3. often involves fusing together two or more bones in the spine, doctor may also put in a metal rod or other device. These devices are called implants. They stay in the body and help keep the spine straight after surgery.

FUSION

MOST SCOLIOSIS OPERATIONS INVOLVE FUSING THE VERTEBRAE. THE INSTRUMENTS AND DEVICES USED TO SUPPORT THE FUSION VARY. IN THE FUSION PROCEDURE, THE SURGEON WILL: SLICE FLAPS TO EXPOSE THE BACKS OF THE VERTEBRAE THAT LIE ALONG THE CURVE. REMOVE THE BONY OUTGROWTHS ALONG THE VERTEBRAE THAT ALLOW THE SPINE TO TWIST AND BEND. LAY MATCHSTICK-SIZED BONE GRAFTS VERTICALLY ACROSS THE EXPOSED SURFACE OF EACH VERTEBRA, BEING CAREFUL THAT THEY TOUCH ADJOINING VERTEBRAE. FOLD THE FLAPS BACK TO THEIR ORIGINAL POSITION, COVERING THE BONE GRAFTS. THESE GRAFTS WILL REGENERATE, GROW INTO THE BONE, AND FUSE THE VERTEBRAE TOGETHER.

This adolescent girl had a 50 curvature treated by thoracoscopic technique resulting in excellent correction. Note the spontaneous correction of the un-operated lumbar curvature. Also note the small, wellhidden incisions associated with the procedure.

About Other Treatments for Scoliosis

So far, the following treatments have not been shown to keep curves from getting worse in scoliosis: Chiropractic treatment Electrical stimulation Nutritional supplements Exercise

INDICATIONS FOR ORTHOSES INCLUDE THE FOLLOWING:


1. 2. 3. 4. 5. Pain relief Mechanical unloading Scoliosis management Spinal immobilization after surgery Spinal immobilization after traumatic injury 6. Compression fracture management 7. Kinesthetic reminder to avoid certain movements

CONTRAINDICATION FOR ORTHOSIS IS:


Discomfort
Decreased pulmonary capacity Increased energy expenditure with ambulation Difficulty with transfers Psychological and physical dependency

Local pain
Osteopenia Skin breakdown Nerve compression Ingrown facial hair in men Muscle atrophy with prolonged use

Increased segmental motion at the ends of the Orthosis


Unsightly appearance Poor patient compliance

SCOLIOSIS ORTHOSIS, BOSTON BACK BRACE

LUMBOSACRAL FLEXION-EXTENSION CONTROL ORTHOSIS (CHAIRBACK)

TLS F-E-L CONTROL ORTHOSIS (KNIGHT-TAYLOR)

scoliosis is not typically associated

with back pain. In cases with back pain, the symptoms can be lessened with physical therapy, massage, exercises, yoga. These can help to strengthen the muscles of the back. They are not, however, a cure for scoliosis and will not be able to correct the abnormal curve.

THE END THANKS ALL