Approach to spine deformity

Scoliosis

-                    Postural scoliosis

-                    Structural scoliosis

• (idoipathic scoliosis)
• congenital or osteopathic
• neuropathic, myopathic
• connective-tissue disorders

-                    Clinical presentation

• Deformity
• Pain

-                    PE

• Standing
  • Plumb line( sagittal , Vertical)
  • Adum forward bending
  • Flexibility test
• Supine
  • Flexibility test
• Other
  • side-on posture for Kyphosis, Lordosis
  • leg length
  • general examination
  • neurological examination
    • Motor , Sensory, Reflex
• Plain X-ray
  • Full-length posteroanterior (PA , lateral x-ray)
    • Cobb’s angle
    • Skeletal maturity evaluation
      • Risser’s sign
      • iliac apophyses
• CT ,MRI
  • In case of suspected intraspinal abnormallity
• Pulmonary function test
• Biochemical and neuromuscular investigation

-                    prognosis & treatment

• idiopathic scoliosis
• Infantile type
  • resolving type 90%
    • Follow up
    • progressive type 10%
      • serial casting
      • Surgery when progression
• Juvenile type
  • 20-30 degree : Brace
  • > 50 degree: surgery
• Adolescent type
  • <20 degreeàObserve
  • 20-30 degreeàBrace
  • Surgery
    • Indication
      • Pre-adolescent with curve more than 30 degree
      • Curve Progression
      • Loss balance

-                    complications of surgery

• neurological compromises
• spinal decompensation
• pseudarthrosis
• implant failure