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SCOLIOSIS

DINA APRILYA

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THE SPINE

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Normal curvature
Thoracic spine
kyphosis 30o (10-40o)
T5 - T12.

Lumbar spine
lordotic 55o (35 -80o)
T12 - S1

Junctional region

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SCOLIOSIS

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SCOLIOSIS
Apparent lateral (sideways) curvature of
the spine.

lateral
anteroposterior
rotational

3D

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CLASSIFICATION
Idiopathic
Postural

2 Broad
type

Osteopathic
Structural
Neuropathic
Miopathic

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POSTURAL SCOLIOSIS

Leg length discrepancy (true or relative)


Pain and muscle spasm (HNP,sciatic scoliosis)

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STRUCTURAL SCOLIOSIS
Lordoscoliosis associated with rotational
buckling of the spine.

Compensatory 2nd curved

Correctable

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Fixed

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Nature of the disease


ROMANTYS
1. The gROwth potential of the patient
2. The MAgNitude of the curve
3. The TYpe of curve
4. The Sex of the patient

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1. The growth potential


Age
Secondary sex characteristics or
menarche
Skeletal maturity

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2. The magnitude of the curve

Cobb
Angle

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Plumb line offset

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3. The type of curve

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4. The Sex of the patient

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Clinical features
Deformity
Backache
Pain
Family history, pregnancy, childbirth
Skin pigmentation, sacral dimples, hair tufts
Rib hump
Cardiopulmonary

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Back Exam
History taking
Deformity: onset, progression
Backache: onset, progress,
temporary/permanent,
type,aggreviate/aleviate, localize/radiate
History: congenital, infection, neoplasm,
trauma, others (family history, antenatal and
birth)

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Flexion 80o
Extension 30o
Lateral Flexion 35o
Rotation 45o
Meningeal sign

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- Pain
-Muscle spasm

ROM

Skin temp
Tenderness
Bone and soft tissue contour
Costovertebral expansion

Feel

Skin pigmentation, texture,


abnormalities
Bone and soft tissue contour

Look
Erect

Back Exam-thoracolumbal

Back Exam

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Imaging
X ray
PA, Lateral (erect), Lateral (bending)
Cobbs Angle, Plumb Line (coronal balance),
Rissers sign

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Classification
King moe
Lenke

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King moe classification

2
T<L

2
K2 T>L

K1

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K3

1T

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K4
Long T-L4

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K5
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2T

Lenke classification

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Intervention

Stop Progression
Save Correction
Restore Balance
Improve QOL

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Non operative
Exercise balancing
Bracing stop progression

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Underarm Thoracolumbar Sacral


Orthoses (TLSO)/Boston brace
Underarm thoracolumbar sacral
orthoses.
partial curve correction Pads
For curves with an apex below T7 or
T8.

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Exercise

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Operative
curves >30 or 40 degrees in growing
child,cosmetically unacceptable or marked
progression during the growth spurt
milder deformity that is deteriorating rapidly.
Balanced, double primary curves require
operation only if they are greater than 40
degrees and progressing
In a mature adolescent, curves that either
progress to or are noted to be in the 50-60
degree
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Objectives
halt progression
straighten the curve (including the rotational
component)
arthrodese the entire primary curve by bone
grafting

Procedure
Posterior instrumentation
Anterior instrumentation
Combined
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Posterior instrumentation
-Harrington system
a rod applied posteriorly along the
concave side of the curve;
attached to the rod were movable hooks
that were engaged in the uppermost and
lowermost vertebrae so as to distract the
curve.
If the curve is flexible, it will passively
correct
bone grafts are then applied to obtain
fusion over the length of the curve.
A major drawback of the original
distraction instrumentation is that it does
not correct the rotational deformity at the
apex of the curve and thus the rib
prominence remains virtually unchanged
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Rod and sublaminar wiring (Luque)


Modified Harrington system
Wires are passed under the vertebral laminae at multiple levels and
fixed to the rod on the concave side of the curve, thus providing a
more controlled and secure fixation.
By bending the rod and arranging the mechanism so that the wires
pull backwards rather than merely sideways, the rotational
component of the deformity can also be substantially improved.
However, the sublaminar wires are dangerously close to the dura
and the risk of neurological damage is increased

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Cotrel-Dubousset system
This mechanism combines a pedicle screw box foundation at the
caudal end of the deformity, with multiple hooks which can be
placed at various levels to produce either distraction or
compression.
With double rods one can distract on the concave and compress on
the convex side of the curve
by appropriate manipulation of the implants one can obtain
correction also in the sagittal plane
It has been claimed that this system can correct the rotational
deformity
It is also sufficiently rigid to make postoperative bracing
unnecessary

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Anterior instrumentation

approaching the spine from the front, removing the discs throughout the curve and
then applying a compression device(either a braided cable or a rod linking transverse
vertebral body screws along the convex side of the curve
Bone grafts are added to achieve fusion.
In some cases combined anterior and posterior instrumentation is necessary
Advantages of this system are:
(1) Provides strong fixation with fewer vertebral segments having to be fused
(2) Overall shortening of the deformed section (by disc excision and vertebral
compression) lessens the risk of cord injury due to spinal distraction.
now performed endoscopically through several ports reduce the morbidity
associated with open thoracic surgery and rib resection.

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Combined approach
Combined Anterior and Posterior
approaches to the spine are
used for large stiff curves or in
double major curves where the
surgeon is looking to stop the
lowest most fused segment
shorter and save a motion
segment in the lumbar spine.
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Wake up test
anaesthesia is reduced a semi-awake state
instructed to move their feet
cord compromise the instrumentation is
relaxed or removed and reapplied with a
lesser degree of correction

Rib hump
Costoplasty

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Complication
Neurological compromise
Spinal decompensation
(unbalanced spine)
Psudoarthrosis
Implant failure
Crankshaft Phenomenon

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References
http://www.eurospine.org/p31000269.html
Solomon L, Warwick D, Nayagam S. Apleys System of
Orthopaedics and Fractures. Ed 9. Hodder Arnold,
London 2010
Breakwell LM, Lenke LG, Gilden JJ. The Lenke
Classification of adolescent idiopathic scoliosis.
COLUNA/COLUMNA. 2006;5(1):13-18
Focus On Classification of adolescent idiopathic
scoliosis. The British Editorial Society of Bone and Joint
Surgery. 2013 . http://www.boneandjoint.org.uk

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THANK YOU

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