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    This document discusses various spinal deformities including scoliosis and hyperkyphosis. It covers the etiology, classification, epidemiology, natural history, and treatment approaches for different types of scoliosis and hyperkyphosis. The main types discussed are idiopathic scoliosis, Scheuermann's kyphosis, and osteoporotic vertebral fractures. Treatment depends on the type and severity of the deformity, and may involve bracing, exercises, or surgery to stop progression and correct the alignment of the spine.

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    Spinal Deformities New

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    1K views79 pages
    This document discusses various spinal deformities including scoliosis and hyperkyphosis. It covers the etiology, classification, epidemiology, natural history, and treatment approaches for different types of scoliosis and hyperkyphosis. The main types discussed are idiopathic scoliosis, Scheuermann's kyphosis, and osteoporotic vertebral fractures. Treatment depends on the type and severity of the deformity, and may involve bracing, exercises, or surgery to stop progression and correct the alignment of the spine.

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    This document discusses various spinal deformities including scoliosis and hyperkyphosis. It covers the etiology, classification, epidemiology, natural history, and treatment approaches for different types of scoliosis and hyperkyphosis. The main types discussed are idiopathic scoliosis, Scheuermann's kyphosis, and osteoporotic vertebral fractures. Treatment depends on the type and severity of the deformity, and may involve bracing, exercises, or surgery to stop progression and correct the alignment of the spine.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    1K views79 pages

    Spinal Deformities New

    Uploaded by

    api-26159412
    This document discusses various spinal deformities including scoliosis and hyperkyphosis. It covers the etiology, classification, epidemiology, natural history, and treatment approaches for different types of scoliosis and hyperkyphosis. The main types discussed are idiopathic scoliosis, Scheuermann's kyphosis, and osteoporotic vertebral fractures. Treatment depends on the type and severity of the deformity, and may involve bracing, exercises, or surgery to stop progression and correct the alignment of the spine.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 79

    Spinal deformities

    Yoram Anekstein M.D.


    Assaf Harofeh Medical Center
    Spine Surgery Unit
    Anatomical alignment of
    vertebral column
    Spinal deformities
    • Scoliosis - coronal.
    • Hyperkyphosis/hypokyphosis -
    sagital.
    Spinal deformities -
    Etiology
    • Idiopathic
    • Degenerative
    • Post-traumatic
    • Infectious
    • Pathologic
    • Congenital
    • Metabolic
    • Inflammatory
    Scoliosis
    Scoliosis

    The scoliotic patient


    actually has a 3D
    deformity.
    Scoliosis
    Two groups of patients
    Many different types of diseases

    Pediatric

    Adult
    CLASSIFICATION

    Pediatric scoliosis

    1. Structural scoliosis
    2. Nonstructural scoliosis
    CLASSIFICATION
    Nonstructural
    1. Postural
    2. Nerve root irritation
    -Disc hernia
    -Infection
    -Tumor
    3. Leg length discrepancy
    4. Lower limb contracture
    CLASSIFICATION
    Structural scoliosis
    1. Idiopathic
    2. Neuromuscular
    3. Congenital
    4. Neurofibromatosis
    5. Traumatic
    6. Extraspinal
    7. Skeletal displasia
    8. Metabolic
    9. Mesenchymal
    Idiopathic scoliosis -
    defenition

    “Structural lateral curvature of the


    spine for which no cause can be
    established”.
    Idiopathic Scoliosis

    1. Infantile (0-3 Years)


    2. Juvenile (3-10 Years)
    3. Adoloscent (>10 Years)
    Epidemiology in idiopathic
    scoliosis
    • Mild = 25/1000
    • Sever = 1-3/1000
    • Female/Male ratio:
    – Mild = 1.4
    – Sever = 10
    GENETICS
    in idiopathic scoliosis

    HEREDITARY DISEASE ??
    1. Increased incidence in family
    members.
    2. Multiple gene inheritance
    3. Gene & gene products are
    unknown.
    CAUSATIVE FACTORS
    in idiopathic scoliosis
    • Paravertebral musculature, spinal
    ligaments and bone pathology.
    • Endocrine
    • Central Nervous System
    • Melatonin (pinealectomy in
    chikens).
    NATURAL HISTORY
    in idiopathic scoliosis
    1. Curve progression.
    2. Back pain.
    3. Pulmonary function.
    4. Mortality.
    5. Psychosocial effects and body
    image.
    Curve progression
    in idiopathic scoliosis

    1. Curve specific factors


    -Larger curve>Smaller curve
    -Female>10 time than male
    2. Growth potential
    - immature patient > mature
    Curve progression

    After maturity if >


    50 to 75 deg, than
    1 degree/year.
    Pulmonary Function

    1. With thoracic curves.


    2. Lordoscoliosis.
    3. Cobb 100-120 degr.
    History
    Differential Progression
    Diagnosis
    • Signs of puberty
    • Family history (menses)
    • Pain !! • Age of onset &
    • Neurologic rate of
    symptoms. progression.
    Screening test
    Physical examination

    Essentials (2).lnk
    Physical examination
    • Limb length
    • Skin signs
    • Pubertal development (Tanner)
    Radiologic assessment
    • Standing radiograph of entire spine
    in AP & lateral projections.
    • Lateral bending radiographs (for
    surgical planing).
    Types of idiopathic
    scoliosis
    King classification
    Idiopathic = right thoracic.
    Cobb angle

    • RT T6-L1 50
    Apex T10
    • LT L1-L5 30 5
    0

    30
    Lateral bending
    radiograph

    22

    RT T6-L1 50 >
    22
    MRI - indications
    • Structural abnormalities.
    • Left thoracic curve.
    • Neurologic signs.
    • Rapid progression.
    • Early onset.
    Structural abnormalities -
    example
    No radiation - Orthoscan
    Idiopathic scoliosis
    TREATMENT
    Idiopathic scoliosis
    TREATMENT

    Only Brace and Surgery are


    effective.
    Idiopathic scoliosis
    TREATMENT GUIDLINES
    • Curve magnitude
    – If > 25 deg = Brace
    – If > 40-50 deg = surgery
    • Curve progression.
    • Skeletal maturity.
    Bracing
    Boston type (TLSO)
    Milwaukee
    (CTLSO)
    Bracing
    • Cheneau
    TREATMENT -
    Conservative
    * What is the deformity we are
    treating?
    * Why are we treating it?
    * Do we treat it successfully
    conservatively?
    TREATMENT -
    Conservative
    * PHYSIOTHERAPY?

    1. For the sagittal component


    2. Maintain muscle tone
    3. Post surgery
    4. At the end of conservative
    treatment
    TREATMENT - Surgical

    • Progressive
    • large curve >50 deg
    • THE GOALS:
    – Stop progression
    – Get a balanced
    spine
    – Correct deformity
    TREATMENT - Surgical
    approaches
    1. Posterior
    - Thoracic
    2. Anterior
    - Lumbar / Thoracolumbar
    3. Combined
    - Rigid
    -Young child
    - Severe curve
    Distraction/Compression
    devices
    (Harrington).
    Translation producing
    devices
    (Luque)
    Derotation/3 “D”
    Correction
    b
    TREATMENT - King type 2
    Posterior approach
    Anterior approach
    Anterior approach
    COMPLIATIONS
    1. Instrumented related
    2. Correction related
    3. Surgical related
    Scoliosis - Summery
    • “Many” different diseases and
    etiologies.
    • A 3D deformity
    • In the pediatric age: Adolescent
    Idiopathic Scoliosis is most
    common
    • Look for structural and neurologic
    abnormalities.
    Scoliosis - Summery
    • Progression is related to curve
    magnitude and to skeletal
    maturity.
    • Clinical approach:
    – Follow up
    – Brace
    – Surgery
    • The goal of treatment - Stop
    progression and get a well
    THANK YOU
    HYPERKYPHOSIS
    HYPERKYPHOSIS
    in children and
    adolescents
    • Postural
    • Scheuermann’s
    • Congenital
    • Skeletal Dysplasia - Achondroplasia
    Postural Round Back
    • Flexible thoracic curve of 45-70
    degrees.
    • Poor posture & extensor musle
    tone.
    • Poor cosmetic appearance and
    increase in back pain.
    Postural Round Back
    Postural Round Back
    Scheuermanns kyphosis
    • Idiopathic
    • Genetic transmission
    • Onset at around age of 10
    (Prepuberty).
    •A rigid Hyperkyphosis
    Scheuermanns kyphosis
    Types

    • Thoracic - apex at T7-T9


    • Thoracolumbar - apex at T10-L1
    • Lumbar
    Scheuermanns kyphosis
    Clinical problems

    • Cosmetic deformity
    • Pain
    • The natural history tend to be
    benign.
    Scheuermanns
    kyphosis

    Radiographic criteria
    • Kyphosis > 40 deg
    • Vertebral wedging
    (> 5 deg in 3 consecutive
    vertebrae)
    • Irregular end plates & Schmorles
    Scheuermanns
    kyphosis
    Treatment

    • Follow-up and exercises.


    • If 50-75 deg in immature patient -
    Brace.
    • If > 80-90 deg in mature patient -
    surgery.
    Bracing of hyperkyphosis
    Scheuermanns kyphosis
    Scheuermanns kyphosis
    Hyperkyphosis
    in adults
    • Post-traumatic
    • Infectious - Potts disease
    • Skeletal Dysplasia - Achondroplasia
    • Metabolic - Osteoporotic
    • Inflammatory - Ankylosing Spondylitis
    • Postsurgical - Laminectomy
    Potts disease
    Once, a common etiology to
    hyperkyphosis
    Osteoporotic Vertebral
    Fractures
    • 700,000 per year in US.
    • Is it a benign problem ?? - NO !!
    • Pain > inactivity > more bone loss
    > more fractures
    • Deformity > reduced lung function
    • Possible neurologic deficit
    Osteoporotic Vertebral
    Fractures
    Increased mortality
    • 5 y survival worse than age
    matched peers
    • Hip # - high death rate within 6 mo
    but back to baseline at 2 y
    • Vertebral # - steady decline in
    survival
    Osteoporotic Vertebral
    Fractures
    Kado, Arch Intern Med 1999
    • Prospective, 8 years, 9575
    patients.
    • VCF increase mortality rate in 23-
    34%.
    • Most common cause of
    death: pulmonary diseases.
    Minimally-invasive
    treatment for VCF
    Vertebroplasty
    • France 1986
    • Percutaneus high pressure
    injection of cement.
    • 70-90% pain relief.
    • Well tolerated.
    Vertebroplasty
    Vertebroplasty
    Minimally-invasive
    treatment for VCF
    Vertebroplasty - complecations
    Up to 65% leak
    3% radicular pain
    Cement PE - reported
    Neurologic def. - rate unknown
    “Maximally”-invasive
    treatment for VCF
    • Indication: neurologic deficit and/or
    sever deformity.
    • High rate of mechanical and
    medical complications.
    Conclusions

    New trends in spine surgery:


    • Minimally invasive techniques for
    treating osteoporotic spinal
    fractures.
    • Spinal fusion for this population
    carry hign risks.
    THANK YOU

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