SCOLIOSIS

Scoliosis is defined as a lateral curvature of the

spine. Different causes may show similar clinical
findings. But the difference lies in the progress and
prognosis of the scoliosis
Classification
postural scoliosis
structural scoliosis
• Postural scoliosis
It is common in the people of younger age .It does
not show the structural changes in the spine . It does not
show the rotatory deformity and it does not progress it is
corrected by using the spinal exercise
Structural scoliosis
it is caused due to various factors
• idiopathic neuropathic
infantile poliomyelitis
juvenile cerebral palsy
adolescent neurofibromatosis

Osteopathic myopathic
congenital hemivertebrae muscular dystrophy
fused vertebrae arthrogryposis
 Idiopathic scoliosis

it is the most common form and it is classified into

three
infantile (3yrs or less)

juvenile (4 -10yrs)

adolescent (10 -18)

•
Paralytic scoliosis
• it is caused by the paralysis of some group of
spinal and abdominal wall muscles .It is caused mainly due
to poliomyelitis ,cerebral palsy, and muscular dystrophy .
This type results in gross deformity depending upon the
extend of muscle paralysis . It needs surgical correction and
fusion
Congenital scoliosis
• it is caused due to vertebral anomalies
• it is usually associated with neural tube defects such as
diastematomyelia and congenital anomalies in other system
Pathological changes
• Muscle commonly elongated and weak:
muscles on convex side
hip abductor muscle
foot pronator muscle
Muscle commonly short and strong:
muscle on concave side
hip adductors on convex side
foot supinators on short side
Joint commonly affected
• lumbar spine atlantooccipital joint
• thoracic spine temparopmandibular joint
• pelvic joints
• hip joint
• foot joints
• scapulothoracic joint
• glenohumeral joint
• cervical spine (torticollis)
Curves in scoliosis
In scoliosis ,there is main curve called primary
curve .the name of the scoliosis is according to the level and
side to which the main convexity of the curve is directed
for eg, the term LEFT DORSAL SCOLIOSIS, denotes the
convexity of the main curve is towards the left side and is at
the dorsal level
the primary curves compensatory curves above
and below the main curve is call is called secondary curve
Dorso lumbar scoliosis
Pattern of scoliosis
• Thoracic scoliosis
• Thoracolumbar scoliosis
• Cervicothoracic scoliosis
Clinical features
• Prominence of posterior chest wall and scapula on one side
• In thoracic curves dorsal angulation of ribs producing the rib hump
• Asymetry prominence of hip
• Skin pigmentation
• Limb length changes occurs
• Pulmonary function is affected
investigation
x ray
CT scan
MRI
Radiography of whole spine is done to assess the degree of curve and the
degree of curve is assess by cobb angle

• Curves are categorized into three

• mild - <25 degree
• moderate- 25 -25 degree
• severe -> 45 degree
General examination
Leg length inequality
Shoulder height difference
Waist asymmetry and pelvic tilt
Foot deformities
Neurofibromatosis
Truncal shift
Neurological examination
• Motor examination:
for upper and lower limb
• Reflexes
abnormal abdominal reflex
clonus
hoffmans sign
Babinski sign
• Gait analysis
Physical test
• Forward bending test
treatment
• In mild cases
periodic observation is done to detect the progression of
deformity
ask the patient to sleep in the side if concavity
postural correction can be obtained by giving heel and sole raise in
the convex side
spinal and breating exercise are prescribed
In moderate cases
• active correction is by MILWAUKEE spinal brace
In severe cases
Rapid progression of deformity is corrected by surgical
procedure .the surgery consist of correction of correction of primary
curves and spinal fusion

correction is done by spinal instrumentation by Harrington rod,

luque rod, and cotrel –Dubousset implants .Fusion is carried out using
cancellous bone graft
Instruments for surgery
Surgical correction