SCOLIOSIS
SCOLIOSIS
- Scoliosis is the sideways curvature of the spine.
CLASSIFICATION
- Non-structural (transient)
- Structural (permanent)
- In structural scoliosis, the vertebrae, in addition to sideways tilt, are rotated along their long axis.
- In non-structural scoliosis they are not.
Non-structural scoliosis:
- Mobile ortransient scoliosis.
Has 3 subtypes:
- Postural scoliosis: commonest
- Compensatory scoliosis
- Sciatic scoliosis
Structural scoliosis:
- Scoliosis with a component of permanent deformity.
The following are the different subtypes:
- Idiopathic: commonest type of structural scoliosis
- Congenital scoliosis
- Paralytic scoliosis
- Sharp kyphoscoliosis (Neurofibromatosis)
PATHOLOGY
- The main pathology is lateral curvature of a part of the spine.
- This is called the primary curve.
- The spine above or below the primary curve undergoes compensatory curvature in the opposite direction.
- These are called the compensatory or secondary curves.
- The lateral curvature is associated with rotation of the vertebrae.
- In curves of the thoracic spine, rotation of the vertebrae leads to prominence of the rib cage on the convex side, giving rise to a rib hump.
Clinical features:
- In most cases, visible deformity is the only symptom.
- Pain is occasionally a feature in adults with a long-standing deformity.
- Sharp angulation of the spinal cord over the apex of the curve may result in interference with cord functions, leading to a neurological deficit.
Radiographic assessment of the scoliosis patient
Cobb method for measurement of scoliosis
- Cobb’s angle – an angle between the line passing through the margins of the vertebrae at the ends of the curve.
Reisser’s sign
- The Risser Sign identifies the amount of ossification (the process of cartilage becoming bone) of the human pelvis as a measure of skeletal maturity.
- The amount of ossification is graded from 0 – 5. The process begins at the front of the pelvis and moves towards the spine.
The grades are as follow:
- Grade 0 – no epiphysis present
- Grade 1 – 25% of the epiphysis present
- Grade 2 – 50% of the epiphysis present
- Grade 3 – 75% of the epiphysis present
- Grade 4 – 100% of the epiphysis present
- Grade 5 – Fusion of epiphysis to the ilium
- The risser sign is very important in calculating the risk of progression of a scoliosis, as it is a sign of skeletal maturity.
- The lower the risser score the higher the risk of progression of a scoliosis (as skeletal growth is still occurring).
Rotation of a vertebra
- Appreciated by looking at the position of the spinous processes and pedicles on AP view.
- Normally, a spinous process is in the centre of the vertebral body.
TREATMENT
Principles of treatment:
- Aim of treatment is to assess the prognosis of the curve in terms of the visible deformity it is likely to produce.
This depends upon:
- the type of the curve
- age at onset
- the site of the curve
Non-operative methods:
- Milwaukee brace
- Boston brace
- Reisser’s turn-buckle cast
- Localiser cast: This is a body cast applied with the spine in traction.
Operative methods:
- Comprise of fusion of the spine.
- In congenital scoliosis, simple fusion is sufficient.
- In idiopathic scoliosis, the spine is fused after achieving some correction by stretching the spine.
Exam Important
- Progression of congenital scoliosis is least likely in Block vertebra.
- Scoliosis is the most common skeletal manifestation in Type-1 Neurofibromatosis
- Increased RV/TLC is seen in a preoperative pulmonary function test, done in a patient with severe kyphoscoliosis
- Spastic quadriplegia is commonly associated with scoliosis and other orthopedic problems
- Musculo skeletal abnormality in neurofibromatosis is Scoliosis , Cafe au lait spots & Hypertrophy of limb.
- Unilateral elevation of diaphragm is commonly due to Scoliosis.
- Vertebral rotation in scoliosis is checked in Forward bending.
- Milwalkee brace is used in treatment of Scoliosis
- Turn-buckle cast is used for Scoliosis.
- Risser Localiser cast is used in the management of Idiopathic scoliosis.
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