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27 Cards in this Set

  • Front
  • Back
Define lordosis, kyphosis, and scoliosis...
Which one is abnormal?
What plane is scoliosis?
Lordosis: Normal curvature of the cervical and lumbar areas
• Kyphosis: Normal curvature of the thoracic area
• Scoliosis: abnormal curve, primarily in the coronal plane
How do you name a scoliosis curve?
side of convexity (opposite side of side bent)
1. Most common scoliosis curve?
2. Second most common?
3. Third?
4. Least?
5. leasters
1. right thoracic curve (side bent left)
2. - Next is a double major curve ‐ thoracolumbar, Note pelvic imbalance
3. Single thoracolumbar curve
4. Double thoracic (R and left in thorax)
5. Single lumbar curves are not common
What are the common causes of scoliosis? Describe each type below (M vs. F)
a. infantile
b. Juvenile
c. Adolescent
idiopathic
-Infantile (0-3) M>F,
- Juvenile (4-puberty)
- Adolescent (puberty)
Infantile scoliosis information
-Infantile (0-3) M>F, convex left (only left predominant type), thoracolumbar, >35degrees surgery
b. Juvenile scoliosis
Curves appear around ages 6‐9
None resolve spontaneously, progress steadily
• Refer if Cobb angle > 200
• Treatment= casting ‐ bracing ‐ surgery‐ OMT ‐exercise
c. Adolescent scoliosis
Most common presentation
• 80% of all children with scoliosis
• Incidence is almost equal
– (female 1.5 : male 1.0)
• Progression to surgery
– Female 8.1 : Male 1.0
– American Academy of Orthopaedic Surgeons Position Statement
• Screen girls ages 10 & 12 (grades 5 and 7)
• Screen boys ages 13 or 14 (grades 8 or 9)
– Deformity increases with growth spurt
For etiologies of scoliosis describe the concepts of failure of formation vs failure of segmentation
formation- – wedge vertebrae (partial unilateral) – hemivertebrae (complete unilateral),• partial segmentation, • non‐segmented

Segmentation - unilateral unsegmented bar – bilateral (bloc vertebrae)
What are the two related anomalies to scoliosis?
UTI- 20% (6% is lifethreatening)
Cardiac- 10-15%
Spinal Dysraphism = up to 20%
– failure of spine to close properly along midline and may also lead to club feet, pes planus, lower
extremity asymmetry
Why might surgery be the last option and only last option for younger patients with scoliosis?
surgery will stop growth due to fusion of bones
For etiologies of scoliosis describe the ...
Anterior/posterior theory
Anterior ‐ Posterior Muscle imbalance
– not well supported
– muscles stretch
• Neuro
– section of dorsal nerve roots
– impaired function of small muscles
– created scoliosis
What is an etiology explanation for the most common form of scoliosis (Right curve)
Most common curve ‐ Right
– most people right handed
– normal slight spinal curve to right at heart
– slight imbalance, curve progresses
• possible causes
– abnormal facet
– malaligned facet
– mild trauma
– hormonal changes
How do you correctly assess for scoliosis?
1. Observation- static posture checking landmarks
- have them bend over while touching land marks--> look for "rib hump"
- decide if major or minor curve
2. X-ray- measure
Cobb angle (AP view)- find most cephalad into curve and draw line on most superior angles into curve, and most caudal vertebra whose inferior surface into curve
Describe treatment for following presentations...
a. >20 degrees on presentation (skel immature)
b. 0‐30 degrees (skeletally mature)
a. Ortho referral for f/u and tx, OMT
b.OMT Follow clinically
Describe treatment for following presentations...
a. 10‐20 degrees, asymptomatic (skel. immature)
b. 0 to 10 degrees, asymptomatic, in skeletally immature pt.
a. OMT, After initial ortho eval, PCP can follow Clinical exam and x‐rays q 4‐6 months until mature skeletally

b. OMT, Observation with follow up (every 4‐6 mos) If curve progresses > 5 degrees, refer to ortho
Describe the purpose and success rate of using a brace for treatment
Goal is to halt progression (curve usually at 20‐45 degrees)
Not work for large curves, even with years of tx
Doesn’t always work, even if done properly
‐Need to wear for > 16 hrs/day x 4 yrs
1. What is the purpose of OMT for treatment of scoliosis?
2. What modalities are indicated?
1. The intention is to restore mobility to MS system where possible

2. • All modalities may be used in the overall management
How often and what is long term approach to using OMT for scoliosis?
Regular visits at first followed by occasional
•Patient education is important to success
– Sensitivity to body image an issue to over come – Self stretching of the functional curves a must to maintain
mobility of curve
– Assess tolerability of some OMT techniques vrs. Others
What are the important numbers as far as degrees go with treatment?
Goal – prevent progression to 50 degrees curves of 50 degrees or more at maturity tend to progress, causing problems structurally with lungs/back pain, etc
‐Curves of < 30 degrees at bony maturity usually do not cause disability with aging
Increased pressure on growth plate will retard growth
Heuter-Volkmann Rule: Increased pressure on growth plate will retard growth
What are the overall indications and goals for surgery for scoliosis?
• Goal is to fuse the spine – Prevent further progression
• Adult w/o compromise & no progression – any angle OK
- Adolescent with curves > 40 require definitive treatment or if progression in braces
• Prevent Pulmonary Compromise (>50°)
• Prevent Cardiac Compromise (>75°)
What are the common surgical methods?
1. Harrington Rods
2. Stapling the convexity side of the vertebra to prevent progression
Bone responds dynamically to stresses placed upon it by changing its internal architecture.
Increased stress on the concave side of the curve produces a dynamic increased in the cancellous bone on the side of curvature
Julius Wolff Law
What type of curve is this? Prevelance?
Most common is a right thoracic curve
What type of curvature is this and what is prevalence?
Second most common
double major curve ‐ thoracolumbar
• Note pelvic imbalance
What type of curvature is this and what is rank of prevalence
Single thoracolumbar curve
Third most common
What type of curvature is this and how common?
single lumbar curve
not common at all!!!!