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INTRODUCTION
• “Scoliosis” - Greek word meaning “crooked.”
• It is a lateral curvature of the spine in upright
position.
• The Scoliosis Research Society has defined scoliosis
as a lateral curvature of the spine greater than 10
degrees as measured using the Cobb method on a
standing radiograph.
• Triplanar deformity of lordosis,
rotation & lateral wedging of
vertebrae.
“Normal” alignment
• Spinous processes all line up in a
straight line over the sacrum
Scoliosis is a combination of
• Angular displacement
• Lateral displacement
Lateral displacement • Angular displacement
Classification
• Sciatic Scoliosis
• Hysterical Scoliosis
• Inflamatory Scoliosis
III. Structural Scoliosis
• Idiopathic Scoliosis
Old Classification
Infantile Onset < 3 yrs Age
NEUROPATHIC MYOPATHIC
oMuscular dystrophy
oPoliomyelitus
oUnilateral Amelia
oCerebral palsy
oFriedreich’s ataxia
oSyringomyelia
• TRAUMATIC SCOLIOSIS
• Mid-back pain
• lower back pain,
• neck pain, headaches,
• premature disc and joint degeneration
• Decreased pulmonary function
Descriptive terms
• The side towards which the convexity of the curve is
directed is designated as Right or Left.
• Compound curve-Displacements
in Right & Left direction
• Secondary or Compensatory
curve-Develops as a balancing
response to the primary curve
• Non structural curve- Curve
is flexible and corrects by bending
towards convex side
• Flexibility
KING CLASSIFICATION
Type IV - longthoracic
(10%) - Long thoracic
curve, L5 over sacrum,
L4 tilted into curve
King classification
• Progressive -
– Compensatory or secondary curves develop,
• Uncommon
• Prognosis is worse
• Commonest type
• Age 10- 16 yrs
• Primary thoracic curve usually convex to right
• Lumbar curves to the left
• Intermediate (thoracolumbar) & combined (double
primary) curves also occur
• Curves under 20 degree either spontaneously or remain
unchanged
ADOLESCENT IDIOPATHIC SCOLIOSIS
Proposed etiological factors,
• Reliable predictors of
progression
2) Marked curvature
3) Incomplete Risser sign at
presentation
Problems in adult life
(1)Back pain,
(2)Pulmonary dysfunction,
(3)Psychosocial effects,
(4)Mortality
THORACOLUMBAR
• Slightly more in females
• Radiologically severe
Bunnell Scoliometer
ADAM’S FORWARD BEND TEST
• Apical vertebra-Vertebra
at the centre of the curv e.
LIPPMAN-COBB METHOD
• Line drawn at end plate of
upper end vertebra
• Bone age
Myelography
Other Studies
Pulmonary function
testing for patients with:
Curves greater than 60
degrees
Respiratory complaints
Scoliosis resulting from
a neuromuscular cause
TREATMENT
Aims of treatment
• Observation
• Orthotics – braces
Non operative
• Exercises maintain muscle tone but no effect
on the curve
• Curve > 40 °
Criteria :-
Disadvantage
• Does not correct the rotational deformity at the
apex of the curve
surgery is done
Indications
INDICATIONS
• Normal mortality
TREATMENT
• For severe lumbar & thoracolumbar curves anterior
fusion with dwyer instrumentation then after 2
weeks posterior fusion with harrington rods.
NEUROFIBROMATOSIS SCOLIOSIS
• Constitutes about 1%
• Associated with skin lesions , multiple neurofibroma
& bony dystrophy affecting vertebra & ribs