Scoliosis

postulated causes of idiopathic scoliosis

- primary muscle disorder (indicated by higher platelet calmodulin levels - a calcium modulating protein for muscle contractility) - disorganized skeletal growth (root cause is probably a gene locus) -potential influence of melatonin (study done in chickens where pineal gland was removed and scoliosis developed) - posterior column lesion

Cobb angle

-measured by determining the most-tilted spinal bones (vertebrae) in each curve -measured by the angle formed between the top of the uppermost titled vertebra in a curve to the bottom of the lower most titled vertebra

The pathophysiology of neuromuscular scoliosis is often attributed to muscle _______ or muscle ________ against ________, but this conclusion is difficult to support because some conditions are accompanied by _________ and others by _________

imbalance, weakness, gravity, spasticity, flaccidity

which type of idiopathic scoliosis has a left thoracic curvature

infantile idiopathic scoliosis

which type of scoliosis has a reputation for spontaneous resolution

infantile idiopathic scoliosis

bone and cartilage of the spine are __________ derivatives

mesodermal

which type of scoliosis entails a thorough assessment of all body systems (nutrition and pulmonary function extremely important)

neuromuscular scoliosis * identifying the underlying disease is essential

subdivisions of neuromuscular scoliosis

neuropathic and myopathic

adolescent idiopathic scoliosis age range

older than 10

Adolescent Idiopathic Scoliosis Progressive curvature may be predicted by a combination of _______ and ________ maturity factors and _______ _______

physiologic, skeletal, curve magnitude

diseases associated with lower motor neuron lesions

poliomyelitis, spinal muscular atrophy

recovery from neuromuscular disorders depend on

previous condition

the control of the curve is often lost with

puberty - surgical stabilization becomes necessary

juvenile idiopathic scoliosis most common curve pattern

right thoracic

an elaborate traction table by Hippocrates focused on spinal manipulation

scamnum

A spinal deformity that presents as a curvature of the spine

scoliosis

the greater the neuromuscular involvement, the greater the _______ of scoliosis

severity

For children with neuromuscular scoliosis, the severity of the curvature may interfere with ________ and ________ further impacting occupational performance

sitting, positioning

another term for idiopathic scoliosis

structural scoliosis

a treatment approach by Hippocrates that involved strapping the patient to a ladder that was lifted in the air and dropped from a height

succussion

nonoperative treatment of neuromuscular scoliosis

thoracolumbosacral orthosis (TLSO) and molded seating supports - controls the curve during growth rather than correcting it

goal of both operative and nonoperative treatment of neuromuscular scoliosis

to maintain the spine in a balanced position in the coronal and sagittal planes over a level pelvis

Cobb angle procedure Lines are drawn along the _____ of the superior tilted vertebra and the ______ of the inferior tilted vertebra. Two more lines are drawn at an angle of ______degrees to these lines, ________ so that they intersect. The resulting angle is measured, and the number is expressed in degrees

top, bottom, 90, perpendicular

neuropathic neuromuscular scoliosis subdivisions

upper and lower motor neuron lesions

When in gestation can spine development be identified

week 3

The two classifications of scoliosis

idiopathic and neuromuscular

first physician to treat scoliosis with a brace

Ambroise Pare - a metal corset with many holes to help diminish its significant weight

outcomes of idiopathic scoliosis linked to

curve magnitude

Treatment recommendations for adolescent idiopathic scoliosis are driven by

curve magnitude *caveat: brace treatment thought to be effective only in patients still growing

infantile idiopathic scoliosis age range

diagnosed younger than 3 years

signs that indicate scoliosis

- asymmetry noted at shoulders, hips, or ribs - head is not centered over pelvis - body leaning to one side

important patient history for scoliosis diagnosis

- family members with spinal deformity - assessing physiological maturity (menarche) - presence/absence of pain

neuromuscular scoliosis how do surgical principles for neuromuscular scoliosis differ from idiopathic scoliosis

- fusion is necessary at a younger age - fused portion of spine is longer - fusion of sacrum common because of poor sitting balance/pelvic obliquity

home adaptations needed following spinal fusion

- higher bed - raised toilet seat - chairs with higher seats

neuromuscular scoliosis increased trunk stability due to spinal fusion will ideally cause

- improved sitting balance - improved respiration - frees up UE to engage in activity

Scoliosis affects _______% of the population

2-3% (6-9 million)

Juvenile Idiopathic Scoliosis observation is the course for curves less than ____ degrees with follow up radiographs regularly

25

Juvenile Idiopathic Scoliosis curves that range from _____ to _____ degrees or those that rapidly progress to ____ usually receive bracing intervention

25, 40, 25

juvenile idiopathic scoliosis age range

3-10

Weeks ________ are especially important for bone and cartilage development of spine, cardiovascular systems, and urogenital systems

3-7

up to _____% of children with neuromuscular conditions present with malnutrition because of feeding and swallowing impairments

30

Adolescent Idiopathic Scoliosis bracing will be used for curves less than

30 degrees

Timeline of spine development At approximately _____ weeks gestation, paired _______ appear. These are segments into which the mesoderm on either side of the embryonic spine becomes divided. Then spinal nerves are present by gestational ________. A discernible cartilage model of the spine is present by gestational ______

4.5, somites, week 6, week 7

Juvenile Idiopathic Scoliosis surgical intervention for inflexible curves that exceed ____ degrees or any curve that exceeds _____ degrees

40, 50

the majority of the spinal canal diameter is achieved by what age?

5

hip movement after spinal fusion

90 degrees of flexion or less

an effective screening tool for asymmetry associated with scoliosis

Adams forward-bending test

Why is there a frequent coexistence of congenital spine anomalies with congenital cardiac and kidney defects?

Bone/cartilage of spine AND cardiovascular/urogenital systems are mesodermal derivatives

diseases associated with upper motor neuron lesions

CP, syringomyelia, and spinal cord trauma

orthopedic Gold Standard for assessing scoliosis

Cobb angle

Physician who used graded exercises for strengthening muscles of the trunk believing the deformity was due to weak axial musculature - did not believe in braces -patients stayed for 1-2 years at his facility for Tx

Jacques Mathieu Delpech

first physician to use surgical treatment for scoliosis

Jules Guerin

physician who popularized the use of a plaster body jacket in mid 1800s for treatment of scoliosis

Lewis Sayre * also used a jury mast extension from his casts - a predecessor to halo traction

three O's of idiopathic scoliosis

Observation Orthosis Operative intervention

juvenile idiopathic scoliosis is more common in

females

physician who introduced the spinal instrumentation system leading to a refined technique - spinal fusion

Paul Harrington * the use of Harrington rods became standard surgical treatment in 1990s

nonoperative treatment of infantile idiopathic scoliosis

TLSO, Milwaukee braces, intermittent Risser casting

Adolescent Idiopathic Scoliosis when is surgery considered

for curves over 40 degrees or rapidly progressing curves

most common type of scoliosis

adolescent idiopathic scoliosis

idiopathic scoliosis is categorized by ....

age of diagnosis

diseases associated with myopathic scoliosis

arthrogryposis, muscular dystrophy, and others

The cause of idiopathic scoliosis is unknown but may be transmitted as an __________ __________or multifactorial trait as it appears to run in families

autosomal dominant

lower levels of self-esteem in scoliosis is associated with

bracing

which nonoperative treatment for idiopathic scoliosis has shown the highest success rate

bracing 23 hours/day (93% success rate)

What plane does scoliosis typically occur

coronal