Spine Patho - Scoliosis
scoliosis occurs in ____________% of children how many children w/ scoliosis require treatment?
0.4-5 1 in 4
if the curve is > 50 degrees, what is progression likely going to be through life?
1 degree/year
In theory, if someone has back/buttock pain of a vascular origin, what is the effect of pedaling a stationary bicycle?
1) If pain into the buttock and posterior thigh occurs, followed by tingling in the affected lower extremity, the first part of the test is positive, but whether it is vascular or neurogenic remains undetermined. 2) FWD bend: If the pain subsides over a short time, the 2nd part of the test is (+) for neurogenic claudication but (-) for vascular-induced sxs. The test is confirmed for neurogenic cause of sxs when the client sits upright again & the pain returns.
what are the 4 types of scoliosis?
1) Infantile idiopathic scoliosis 2) Juvenile idiopathic scoliosis 3) Adolescent idiopathic scoliosis (AIS) 4) Adult scoliosis
list the characteristics of scoliosis (4)
1) asymmetry in shoulders & pelvis; 2) curve designated by convexity of curve; 3) rotational deformity on convex side (rib hump); 4) primary & secondary curves
what are the purposes of surgical intervention for scoliosis? (5)
1) halt the progression of the curve; 2) improve alignment; 3) decrease deformity; 4) prevent pulmonary problems; 5) eliminate pain
list the treatment components of adult scoliosis (9)
1) improve aerobic capacity; 2) strengthen mm; 3) improve flexibility; 4) pain management; 5) nutritional counseling; 6) smoking cessation; 7) nerve blocks; 8) steroid injections; 9) bracing
list the 7 different approaches to scoliosis-specific exercises
1) lyon approach from france; 2) katharina schroth asklepios approach from germany; 3) scientific exercise approach to scoliosis (SEAS) from italy; 4) barcelona scoliosis PT school approach (BSPTS) from spain; 5) dobomed approach from poland; 6) side shift approach from the UK; 7) functional individual therapy of scoliosis (FITS) approach from poland
what are the different factors associated w/ back pain in adults w/ scoliosis? (6)
1) muscle fatigue; 2) trunk imbalance; 3) facet arthropathy; 4) spinal stenosis; 5) degenerative disc disease; 6) radiculopathy
list the clinical manifestations of scoliosis when a curve is > 60 degrees (6)
1) pulmonary insufficiency; 2) reduced lung capacity; 3) back pain; 4) degenerative spinal arthritis; 5) vertebral subluxation; 6) sciatica
what are the 2 rib changes that occur w/ AIS?
1) rotate forward & down on concave side; 2) rotate back & open up leading to a rib hump on convex side - scapular wing or protrusion
what are the 3 vertebral body structural changes that occur w/ AIS?
1) wedging on concave side; 2) SPs rotate to concave side; 3) discs compress on concave side
what is the age range for adolescent idiopathic scoliosis?
10-20 y/o
describe the prevalence of juvenile idiopathic scoliosis
3-10 y/o Right thoracic curve & rapid progression
w/ what scoliometer reading should you refer a pt for a spinal x-ray?
5-7 degrees
how many people in the US have adult scoliosis?
500,000
what are the attitudes toward prescribing PT for scoliosis?
63% of surveyed Scoliosis Research Society members don't prescribe PT
what % of scoliosis cases are idiopathic?
80%
describe the results of the cobb method of diagnosing scoliosis
> 10 degrees is considered to be scoliosis
how large is the curve for adult scoliosis typically?
> 30 degrees
how can cardiovascular conditions present as back pain?
AAA, endocarditis Vascular claudication
In pt w/ scoliosis, there will be a rotational deformity on the ________ side
Convex side rib hump
Post op scoliosis: spinal precautions 6-12 wks post
Flexion, extension, rotation Lifting restriction Need to edu on safe lifting mechanics
possible neuro disorder in presence of _____ thoracic curve
L
list examples of abnormal curvatures (by planes) w/ AIS
Lateral curvature (frontal plave) Rotational deformity (transverse plane) Lordotic deformity (sagittal plane)
_________L/R________ thoracic curves are less common, researches found that 54% of LTC has associated neural tube defect
Left curves -R t-spine curves are in general more common
is back pain typical in children (w/ scoliosis?)?
NO
Post op scoliosis: precautions 6-12 mnths post
Pt can resume all activites
what is the purpose of an orthosis for scoliosis? Goal?
Purpose: serve as a passive restraint Goal: maintain curves within 5 degrees of initial application
describe lateral curvature in the frontal plane (AIS)
R more common in thoracic; L more common in lumbar
Post op scoliosis: precautions 4-6mnths post
Return to non-contact sport
What are the technical names for R & L thoracic curves?
Right = Dextroscoliosis Left = Levoscoliosis
What is the effect of changing the position of the spine on pain of a vascular nature? Are the vascular structures compromised in any way by FWD bending, SBing, or BWD bending?
Vascular supply isn't compromised by position of the spine, so there is usually no change in back pain that is vascular-induced w/ change of position. FWD bend, extension, & SBing don't aggravate or relieve sx. Rather, increased activity requiring increased blood supply to the musculature is more likely to reproduce sxs; likewise, rest may relieve the sxs. Watch for a lag time of 3-5 mins after the start of activity or exercise b4 sxs appear or increase as a sign of a possible vascular component.
what type of scoliosis is most common?
adolescent idiopathic scoliosis (AIS)
abnormal curvature of the spine occurs in ____________ planes w/ AIS
all
which curves are most successfully treated w/ orthoses?
apex T8-L2; compensated T/L curves
which curves have a poorer outcome w/ orthosis treatment?
apex above T6
how do postural/functional curves resolve?
as primary problem is treated
list aspects of Physiotherapy Scoliosis Specific Exercises (PSSE) (4)
auto-correction in 3D; ADL training; postural stabilization; pt education
How is a scoliotic curve named?
based on the curves CONVEXITY
what degree curves are braced?
between 25-40
which gender more commonly has curve of 10 degrees or less w/ adolescent idiopathic scoliosis?
boys = girls
what may happen if functional curve is left untreated?
can become structural
what method is used for diagnostic imaging of scoliosis?
cobb method
what type of care is used when treating scoliosis?
conservative
how can GI conditions present as back pain?
constipation, obstruction crohn's, IBS
when is surgical intervention employed for pts w/ scoliosis?
curve > 45 degrees
when is it considered that progression will be small w/ scoliosis?
curve is < 40 degrees at skeletal maturity small progression
when do structural scoliotic curves increase?
during rapid skeletal growth
what is important when treating scoliosis?
early detection
what is an aspect of conservative care that could potentially be used for all pts w/ scoliosis?
exercise
which gender more commonly has curve > 30 degrees w/ adolescent idiopathic scoliosis?
females > males (10:1)
Structural scoliosis is a ______________ curve
fixed curved - mostly idiopathic - vertebral body congenital deformity
what are the aspects of surgeries for scoliosis?
harrington rods; posterior and anterior fusion
list the potential etiologies of scoliosis
idiopathic osteopathic (spinal disease or bony abnormality) myopathic neuropathic
describe lordotic deformity in the sagittal plane (AIS)
increased lordosis
how can renal/urologic conditions present as back pain?
infection stones
what is back pain caused by 1% of the time?
infection, neoplasm, or systemic inflammation
describe wilmington brace
lower curves; may be slightly more aesthetically appealing; increased ability to move the head; must wear 23 hours/day
describe structural scoliosis
maintain position irrespective of straighten or forward bend; actual bony changes of spine
what is the overall goal of treating scoliosis?
management of curve
what is back pain caused by 97% of the time?
mechanical source
> 50 degree curve = spine is _____________
mechanically unstable
what are the mm that shorten on the concave side w/ AIS?
multifidi; erector spinae; QL; psoas major/minor; obliques
incidence of scoliosis increases with _______________
neuro impairments EX: CP, MD, & Spina Bifida
what does vascular claudication very closely mimic?
neurogenic claudication/sciatic nerve impingement
will low risk children need bracing?
no - avoid the cost!
is using the scoliscore as a means of determining prognosis well-accepted?
no - it's controversial
describe evidence to support bracing adults with scoliosis
not strong
describe tx of scoliosis w/ curve < 25 degrees
observation & monitoring every 4-6 months
describe tx of scoliosis w/ curve of 25-40 degrees
orthoses - keep w/in 5 degrees of initial application
how can infections present as back pain?
osteomyelitis TB
how can pulmonary conditions present as back pain?
pain w/ deep breathing, cough, laugh, SOB
what may functional scoliosis be caused by?
poor posture; leg length; mm spasms; spondylolisthesis
what should you be aware of in presence of L thoracic curve?
possible neuro disorder
what are the pros and cons of a milwaukee brace?
pro - increased level apex (cervical aspect); con - decreased comfort, function, compliance; must wear 23 hours/day
what are the pros and cons of charleston braces?
pro - overstretches pt in opposite direction of curve, only worn at night
what are you trying to prevent w/ scoliosis exercises?
progression (some pts may actually have reduction)
what are the pros and cons of boston braces?
pros - widely used con - not customized, may not be as comfy bc it isn't personalized
how is the screening procedure for scoliosis performed?
pt bends forward 90 degrees w/ hands joint (diving); scoliometer measures angle of trunk rotation
what must you do if you find back pain in a child?
r/o spondylolisthesis, tumor, infection, occult trauma
what is adolescent idiopathic scoliosis caused by?
rapid skeletal growth
Describe the prevalence and age range of infantile idiopathic scoliosis
rare in US 0-3 y/o age range
list the clinical manifestations of scoliosis when a curve is < 20 degrees
rarely causes significant changes
describe rotational deformity in the transverse plane (AIS)
rotation of vertebral column & its axis cause rib cage deformity
how is prognosis in AIS measured?
scoliscore It's a test to predict if a cobb angle of 10-25 degrees will progress to > 45 degrees
is a scoliometer used to diagnose or screen?
screen
what are you trying to prevent when a pt has scoliosis?
severe deformity that would lead to decreased cardiorespiratory function
what soft tissue changes occur w/ AIS?
shortening of mm, ligaments, capsules on concave side
describe functional scoliosis
straighten when placed in forward bend; esp. easy to see when pt is sitting (eliminates WBing through feet); often secondary to leg length discrepancy
what does genotyping do for scoliosis?
stratifies the risk of progression from low, to intermediate, to high
DEscribe PT implications for both stretching & strengthening pt w/ scoliosis
stretch: Hip flexors, back extensors, lateral trunk flexors of concave side strengthen: Core, trunk rotators and extensors, gluts
what are the 2 types of scoliosis you must differentiate between?
structural & functional
describe tx of scoliosis w/ curve > 45 degrees
surgery
how do growth patterns affect the spine??
taller & quicker impacts curve progression
what is the known cause of scoliosis?
there isn't one currently
what is 2% of back pain caused by?
visceral disorders
when is functional scoliosis especially easy to see? why?
when pt is sitting; eliminates WBing through the feet
can cancer present as back pain?
yes
does adult scoliosis often cause back pain?
yes