Scoliosis

Scoliosis, kyphosis, or lordosis Adolescent idiopathic scoliosis

Altered Pediatric Spine Develop when spinal alignment is altered congenital or progressive changes occur such as ___ Left untreated may affect child's pulmonary function, psychosocial well-being, potential for back pain, and life expectancy -24% of school-aged children (7-18 years-old) are at risk for ___ -most common form of scoliosis

C1-C6 C7-T1 T2-T11 T12-L1 L2-L4 L5-S1

Classification of Spinal Curve Based on Location Cervical curve: Cervicothoracic curve Thoracic curve Thoracolumbar curve Lumbar curve Lumbosacral curve

rib-to-rib rib-spine distraction on concave side brachial plexus and multiple outpatient lengthenings

Congenital Scoliosis - Surgical Intervention -Vertical expandable prosthetic titanium ribs (VEPTR) -one or more ___ or ___ configuration is placed -VEPTR placed on the convex side of curve to provide ___ complications include

rapid growth of curve early in life boney anomaly of vertebrae or rib cage with curve flexibility 6 mo

Congenital Scoliosis -Surgical Intervention -indicated for kids while they are still growing due to ___ rapid curve progression, and/or large curve magnitude Expandable growing spinal rod technique -indicated for ___ -serial lengthening performed every ___ during growing years

Lateral and anterior-posterior Iliac crest 0=absence of calcification 5=fusion of iliac crest with ilium and cessation of increase in height

Detection of Scoliosis X-rays both ___ ---used to determine the location, type, and magnitude of the curve ---Cobb method ---skeletal maturity using the Risser sign (Amount of ossification of the ___) (grades 0-5 with ) representing ___ and 5___)

Trunk, shoulder, or pelvic asymmetries An orthopedic surgeon who specializes in scoliosis 5 degrees 20 degrees

Detection of scoliosis Primarily identified by ___ Children with asymmetries should be referred to ___ A minimal measurement of ___ by using scoliometer -good criteria for lateral curve with Cob angle of __ -warrants referral to an orthopedic physician

Age 3 usually after birth Spontaneously resolve Deformity

Idiopathic Scoliosis - Infantile -infantile idiopathic scoliosis develops in children younger than ___ 80-90% of curves ___ ---remaining cases process through childhood and lead to ___

3 and 9 R thoracic 6 deformity 30 degrees

Idiopathic Scoliosis - Juvenile Occurs between ages ___ Most common curve is a ___ with equal frequency in males and females most often recognized at around age ___ high rate of progression and result in severe ___ Curves greater than ___ at beginning of puberty (100% progression to surgery)

sustained increase of 5 degrees or more on two consecutive examinations 4-6 months apart younger age at diagnosis double-curve lower Risser sign greater magnitude of curve females in approximately 10 times than males curves prior to menarche

Idiopathic Scoliosis - Natural history progressive curve defined as ___ main factors that influence progression

5-7 days and PT limited on 2nd day BLT (trunk rotation is contraindicated and log roll required) (no hip flexion past 90 degrees of flexion)

Idiopathic Scoliosis - Surgical Intervention -Average length of stay of a posterior spinal fusion is ___ posterior fusion precautions ___

documented progressive idiopathic curve Posterior spinal fusion (PSF)

Idiopathic Scoliosis - Surgical Intervention major indication for spinal fusion is ___ --Cobb angle reaches 45 degrees or greater in an immature spine --curves greater than 40 degrees have significant risk of protection ____with instrumentation is currently the "gold standard"

Puberty idiopathic 20 degrees 1 degree

Idiopathic Scoliosis- Adolescent Curves beginning at around onset of ___ accounts for 80% of all cases of ___ scoliosis curve greater than ___ or greater 5:1 ration (males to females) structural curves have a greater tendency to progress during adolescence -____ per month if not treated

Idiopathic scoliosis

Lateral curvature of the spine of unknown cause Most common form of scoliosis in children!

faster more SMA and SCI (tetraplegia) myelomeningocele and CP

Neuromuscular Scoliosis compared to idiopathic scoliosis -progress ___ -have ___ disabling outcomes highest prevalence of spinal deformities (90-100%) occurs with a medical diagnosis. such as ___ 60% prevalence of spinal deformity in children with ___ and 25% with ___

support and immobilization don brace for out of bed activity

Neuromuscular Scoliosis - Surgical Intervention orthosis most likely used post operatively for ___ possible orders from physician to ___ discontinued if x-ray positive for bone healing of fusion

10 degrees Right and left convexity Right

Scoliosis Refers to a lateral curvature of the spine Must be greater than ___ with a vertebral rotation component on x-ray Classified according to origin, location, magnitude, and direction Can be idiopathic, neuromuscular, or congenital Direction of curve is based on ___ -90% of thoracic curves are ___

8-14 years-old, 12 yrs 11-16 years-old, 14 yrs

Spinal Development -different for females and males Females: chronological age___ max growth___ Males: chronological age___ max growth ___

Non-surgical and surgical interventions -birth to 3 years old Adolescence

Spinal development Growth of the spin occurs throughout adolescence Knowledge of spinal growth is essential when determining ___ Two periods of rapid spinal growth - -

Posture and movement Head, extremities, and spinal cord trunk flexibility Shock Normal chest and respiratory development

Spine -framework for ___ -supports ___ -allows for ___ -absorbs ___ -structural support for ___

Neuromuscular scoliosis Neuropathic (CP) and myopathic (DMD)

associated with systematic or chronic diseases often has a rapid progression Scoliosis Research Society (SRS) -two categories___

Congenital Scoliosis infantile scoliosis (doesn't have vertebral anomalies on X-ray)

caused by anomalous vertebral development in utero (ex hemi) NOT to be confused with ___ May not be apparent at birth but the anomaly is present abnormalities involving other organ systems in 61% of patients with congenital scoliosis