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