Академический Документы
Профессиональный Документы
Культура Документы
B Y:
S U P ER V IS O R :
DR. KARYA TRIKO BIAKTO, SP.OT (K) SPINE
AN ATO M Y
AN ATO M Y
AN ATO M Y
ARTERIES O F SPIN E
Vein ofSpine
Affect predominantly
the coronal plane
Affecting sagittal
plane
K Y P H O SIS
- Normal spine profile of the thoracic region of the
spinal column
- Normal range of thoracic kyphosis: 20-50 degrees
(Cobb angle from T3 to T12)
Causes ofKyphotic
Classifi
cation
Postural
kyphosis
Structural
kyphosis
Correctable
The sagittal contour
normalizes because the
deformity is flexible
Classifi
cation
Congeni
tal
kyphosis
Adolesc
ent
Kyphosis
Scheuermanns Disease is
defined as three consecutive
levels of at least 5 degrees of
segmental kyphosis (anterior
wedging) at each level
Etiology
ClinicalFindings
Starts at puberty
Affects boy more than girls
Backache and fatigue, sometime
PhysicalExam ination
Angular thoracic or thoracolumbar
PhysicalExam ination
RadiologicalFindings
The criteria for the diagnosis :
RadiologicalFindings
On a lateral view made with patient
RadiologicalFindings
Lumbar
Scheuerm
anns
disease
Schmorls
node
Treatm ent
Non operative
Operative
Curves of 40 degrees
or less
Exercises and postural
training
Follow up with repeat
standing lateral
roentgen every 4 to 6
months
Thoracic type (T6-T8)
more than 500 :
Milwaukee brace
Deformity cant
controlled by brace
patients with a very
rigid kyphosis of more
than 800
Lowe: adults with a
kyphosis of 75
degrees or more and
persistent disabling
pain despite
conservative
management
Treatm ent
Sequele
Backache
Embarrassment about physical
appearance
Interruption of work or disability
Severe progressive deformity
Cardiopulmonary failure
Spondylysthesis
Disc degeneration
D iff
erentialD iagnosis
Postural round back deformities
Spondylitis
Osteochondrodystrophies
Ankylosing spondylitis
S C O LIO S IS
D efi
nition
Scoliosis is an apparent lateral
structural
PosturalScoliosis
StructuralScoliosis
Epidem iology
The incidence is approximately 1% in
Etiology (classifi
cation by its
cause)
ClinicalFinding
Deformity : an obvious skew back or
noted;
the manner in which it was noted;
the perinatal history; developmental
milestones; other illnesses;
and family history of scoliosis or
other diseases that may affect the
musculoskeletal system
Inspection
The trunk should be completely exposed ,
Measurement of decompensation
Neurologic Tests
IM A G IN G STU D IES
X-Ray
In younger patients, special attention is
Risser grade 1 patients have ossified only 25% of their iliac apophysis.
Risser grade 4 patients have ossified 100% of their iliac apophysis, but
have not fused their iliac wing to their ileum. Risser grade 5 patients are
skeletally mature and have ossified their entire iliac apophysis and fused
their iliac wing to the ileum
Curvature
Measurement
Measurement of the Cobb
angle. End vertebrae are
the last levels that are
tilted into the curve
concavity. A line is drawn
from
the
superior
endplate of the superior
end vertebral body, and
another line is drawn from
the inferior endplate of the
inferior vertebral body The
angle of the intersection of
these lines is the Cobb
angle.
P R O G N O SIS A N D
TR EATM EN T
Prognosis is the key to treatment.
Treatm ent
(1) serial casting, progressing to
TREATM EN T
For curves of less than 20 degrees,
Etiology
TREATM EN T
NON OPERATIVE
Operative Treatment
Surgery is indicated:
(1) for curves of more than 30 degrees
that are cosmetically unacceptable,
especially in pre-pubertal children who
are liable to develop marked
progression during the growth spurt;
(2) for milder deformity that is
deteriorating rapidly.
CO N G EN ITAL AN O M ALIES
Congenital scoliosis is a lateral curvature of the
remains
unknown.
During
embryologic
development, these abnormalities develop in
the spine between the fifth and eighth weeks of
gestation, but it is very uncommon to identify
any traumatic or teratologic type of maternal
insult during this stage of pregnancy.
CLASSIFICATIO N
PhysicalExam ination
The skin of the back should be
be very thorough
TREATM EN T
Treatment is more difficult and specialized than
that of idiopathic infantile scoliosis. Progressive
deformities (usually involving rigid curves) will
not respond to bracing alone, and surgical
correction carries a significant risk of cord injury.
These children should be treated in special units:
the approach is to undertake staged resection of
the curve apex, followed by instrumentation and
spinal fusion. If multiple segments of the spine
are involved, surgery may be too hazardous and
should probably be withheld.3
ETIO LO GY
TREATM EN T
Treatment depends upon the degree of functional
REFEREN CE
1. Thompson JC. Netters Concise Orthopaedic Anatomy. Second Edition. Philadelphia: Elsevier Saunders.
p. 31, 65-6
2. Feeman B. Scoliosis and Kyphosis. In: Canale Terry S. Campbells Operative Orthopaedics. 10 th Edition.
Volume One. Philadelphia: Elsevier. 2003.
3. Solomon L, Warwick D, Nayagam S. Appleys System of Orthopaedics and Fractures. Ninth Edition. UK:
Hodder Arnold. 2010. p. 453-70.
4. Devlin Vincent. Spine Secret Plus. Second Edition. Missouri: Elsevier mosby. 2012. P. 10-7, 34-45, 52-8
5. Mummaneni P, Ondra LS, Sasso CR. Thoracolumbar Deformity Advances. In: Haid WR, Subach RB,
Rodts EG. Advances in Spinal Stabilization. Volume 16. Karger. 2003. P.213-24.
6. Schiller J, Craig, Eberson. Spinal Deformity and Athletics. Sports Med Arthrosc. Volume 16, Number 1.
March 2008.
7. Salter B Robert. Textbook of Disorders and Injuries of the Musculoskeletal System. Third Edition.
Lippincott Williams and Wilkins. 1999.
8. Skinner HB, Agudelo JF. Current Diagnosis and Treatment in Orthopaedics. 4 th Edition. USA: The
McGraw-Hill Companies. 2006.
9. Canale, terry. Campbell's Operative Orthopaedics, 10th ed. Congenital Scoliosis. Elsevier London:2007.
10.Anthony B.Congenital Scoliosis. Tachdjians Pediatric Orthopaedics.Philadelphia; 2008
11.Frassica F. Scoliosis.5-Minute Orthopaedic Consult, 2nd Edition. Lippincott Williams & Wilkins:
2007.p.372-5
12.Haid RW. Thoracolumbar Deformity Advances.Advance in Spinal Stabilization.USA: Karger; 2003.p.21320
13.Slakey J. Adolescent Idiopathic Scoliosis: Review and Current Concepts. American Family Physician
www.aafp.org/afp .