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56 Cards in this Set

  • Front
  • Back
What are the 7 factors that is unique about the
“pediatric” spine?
It is not a scaled down version of the adult spine.
Weak growth plate
Changing spinal contours
Immature neuromuscular control system
How growth is unique about the
“pediatric” spine?
Increased growth rate- increased force acting upon the spine.
• Anterior/Posterior spine balance
How Adaptability is unique about the“pediatric” spine?
Adapts to deforming forces more readily the aged
i.e. Compensatory Lumbar curve to large thoracic curve to
center head over pelvis
How Malleability is unique about the“pediatric” spine?
-Easily deformed with application of outside forces
– Malleability decreases with maturity
– Absorption of energy = fewer fractures
How is Hypermobility unique about the“pediatric” spine?
– Young ligaments are more elastic than spinal cord
– Transient subluxation
– Spinal cord injury without radiographic abnormality
How is Changing spinal contour unique about the“pediatric” spine?
– Single kyphosis to lordosis/kyphosis mix
– Sagittal contours stabilize against rotational/coronal plane
How is Weak growth plate unique about the“pediatric” spine?
– Weakest link in the axial skeleton
How is Immature neuromuscular control system unique about the“pediatric” spine?
– Myelination is not complete until 2 years of life
– Subtle abnormalities of complex integration of sensory
stimuli from proprioceptive, visual, and vestibular stimuli:
Dx of Idiopathic Scoliosis?
i.e LLD
what are the 3 types of scoliosis?
. Nonstructural
• Transient Structural
• Structural:
Transient Structural scoliosis
(sciatic, inflammatory, etc)
i.e. pain due to the inflammation
Structural scoliosis:
– Congenital (Vertebral and Extravertebral)
– Neuromuscular (SMA, MMC) & Myopathic (DMD)
– Neurofibromatosis and Mesenchymal
– Neuropathic(SCI,CP,Syringomyelia- cyst or tubular cavity forms within the sc.
– Thoracogenic
– Idiopathic
what are the two types of anomalies of the Spine?
Defects of segmentation
Defects of Formation
What are the three types of defects of segmentation?
1. Block vertebra
2. Unilateral bar
3. Unilateral bar w/hemivertebra
What are the 5 types of defects of formation?
Wedge vertebra
fully segmented
what is the definition of Idiopathic Scoliosis? (what are the 3 conictions needed)
1.Lateral curvature
3.Absence of any relevant congenital spinal anomaly or
associated muscoloskeletal condiction.
what are the 3 Orthotic Considerations for Infantile
• More open design for rapid (trunk) growth
and development
• Growth adjustability
• One of the better indications for a
Milwaukee brace
what is the age range for IIS?
0-3 y/o
For Early Onset Scoliosis when should it consider orthotic treatment?
~ 25 degr
> 2 y/o w/ larger curves
the treatment is ox/ risser casting and/or Halo traction/ orthosis ubtil surgery.
what is the age range for JIS?
Jubenile Ideopatic Scoliosis age range is 4-10 y/o
What is the age range of AIS
Adolescent Ideopatic Scoliosis (puberty onset to epiphyseal
what is the age range for AIS
Adult I.S. (epiphysis closed)
when does spinal growth is greatest?
Spinal growth: is greatest from birth to age 5 years, with
-marked deceleration between ages 5 and 10 years
what is the normal age range for early onset scoliosis?
– Onset of scoliosis unusual between 5 and 10 years of age
– A Dx of “Early Onset Scoliosis” = < 5 years of age at discovery
what factors are necessary Understand Progression of
Adolescent Idiopathic s.?
• Gender
• The deg. of maturity @ the time of curve @ Dx
– Age
– Risser
– Peak growth
• The degree of curvature at the time of discovery
• The location and pattern of the curve
what are the 3 prognostic factors on the progression of adolescent scoliosis?
↑ Curve magnitude
↓ Chronological age
↓ Risser sign
what are the Scoliosis Curve Patterns (according to the apex location)
• Cervical: Apex between C1 and C6
• Cervicothoracic: Apex between C7 and T1
• Thoracic: Apex between T2 and T11
• Thoracolumbar: Apex between T12 and L1
• Lumbar: Apex between L2 and L4
• Lumbosacral: Apex between L5 and S1
Is Hypokyphotic spine more sensitive to axialloads
Hypokyphotic spine may be more sensitive to axial
loads= greater risk for buckling.
What determined the direction of the scoliosis?
local conditions, but is often determined by the lateral
pressure exerted by the aorta -theory convexity of thoracic curves being predominantly to the right).
what happen to children w/ difference on growth on the AP?
do not need to be great.
the greater the difference the
higher the risk of collapse.
what are the Heuter-Volkmann’s principle?
1. Decreased concave growth.
2. Decreased posterior element growth
• W/ out external support to increase the critical load carrying capacity of the scoliotic spine, can result on
further deformity.
Which type of scoliosis (according to the location) tends to progress less?
Single Lumbar and
Single Thoracolumbar
and are the most receptive to brace treatment.
what type of scoliosis according to king classification is more likely to progress?
Single thoracic and double patterns.
what is the orthodox treatment for AIS?
1. Observation
– mature
– curves < 25 degr.
2. Brace:
– more than 2 years of growth remaining
– curves 25-45 degr.
3. Surgery:
– curves >45 degr.
what are the Contraindication to Orthotic Treatment in AIS?
1. Curves >45 deg. in an adol. w/ growth remaining.
2. Emotional intolerability
3. Extr. thor. hypokyphosis /lord
3.Advanced maturity
Risser >/=4; 2 y+ postmenarchal
4.High thoracic or cervicothoracic curves (~ cephalad to T6).
What are the 3 clinical assessment for scoliosis?
1. Shoulder Asymmetry
2. Unequal scapular prominence
3. Appearance of an elevated or prominent hip/LLD
what happen to the ribs and vertebra on the Adam’s forward bending test?
– Spinous process rotate to the curve’s concavity
- vertebral bodies to the convexity
– Thoracic: Rib prominence
– Lumbar: Paraspinal prominence
In tthe Adam’s forward bending test what you will see in the spine according to the location of the curve?
– Thoracic: Rib prominence
– Lumbar: Paraspinal prominence
how many degrees need to be measure in the scoliometer to be referred to the orthopedic surgeon?
7 deg= 20 deg= orthopedic surgeon.
what an you find out w/ Radiographic Assessment?
1. Maturity Indicators (Risser, tri-radiate, radial styloid)
2. Cobb Angle
3. Vertebral Rotation
4. Spinal Decompensation
5. LPR
how do you Orient the x-ray film?
– Heart shadow and stomach bubble to patient’s
- Posterior to anterior
what is King Classification?
classifies scoliotic curves as one of five patterns
what is King I
King I – (lumbar + thoracic) double curve, lumbar curve is more prominent
what is King II
King II – (lumbar + thoracic) double curve, thoracic curve is more prominent
what is King III
King III - Right single thoracic curve
what is King IV
King IV - Long right thoracic curve w/ lower apex
what is King V
King V - Double thoracic curve
what are the 3 Orthotic Treatment Goals for AIS?
1. decreased curve
2. avoid the need for surgical
3. Passive in-brace correction Orthotic Passive in-brace correction what is the predominant corrective force?
2.and what this does?
1.transverse loading of the spine.
2.increases critical load that the spine can carry.
what is the Prescription for
1.Most Scoliosis?
2.L or TL curve < 35°?
3.inf Large curves?
4.Odd shapes/curves?
Prescription Formulation
1.Most Scoliosis-Boston Brace
2.L/TL curve < 35° -Charleston
3.inf Large curves-Milwaukee
4.Odd shapes/curves -Custom TLSO
5.Kyphosis -Milwaukee or TLSO
what are the advantages of the trochanteric extension on the brace?
1. Increase moment arm of the force.
2. Prevent tilting of the orthosis in the coranal/frontal plane.
what are the Orthotic Considerations for the
Treatment of Neuropathic or Myopathic Scoliosis?
Custom molded: Gravity eliminated
• Typically long, “C-shaped” curve.
-consider anterior opening for
improved lateral control, (transverse loading),when possible
patient/caregiver access to closure.
• Pay meticulous attention to bony prominences
- caregiver education (insensate skin)
Soft (framed) design?
Design Considerations (Cont.’d)
• Broad pressure distribution (hydrostatic pressure)
• Hygiene (incontinence; room for diaper?;
polyethylene foam liner contraindicated?)
• May need to forego maximum In-brace reduction
in recognition of patient acceptance
• Pulmonary compromise?(Spinal Muscular
what is the etiology of scheuermann's disease?
anterior wedging of the vertebra due to herniation (schmorl's disc) that interrupt endochondreal ossification.
age of onset- 10-12 y/o
Apex around t7-t9
Often pectoral muscle contraction.
what are the 2 indications for ox
Skeletal immaturity (Risser 0 to 3).
• Curves between 50 deg and 70 deg, with passive
flexibility of no less than 40%.
what are the two OX goal?
keep correction until skeletal maturity.
what are the corrective forces apply to the brace indicated for kyphosis?
Ant. directed force apply to the dorsal aspect of the mid thorax
Post. direct. force apply to ventral aspect of prox. thorax
Anterior directed force to the gluteous.
Post direct force apply to the ant. aspect of prox pelvis.