CONGENITAL SCOLIOSIS-Types, Investigation,Management

SCOLIOSIS

1. DR.GANESAN G RAM
CONGENITAL SCOLIOSIS

2. SCOLIOSIS

•Congenital scoliosis is a lateral curvature of
spine caused by the presence of vertebral
anomalies that result in an imbalance of the
longitudinal growth of the spine.

3. CAUSES
Disturbances occuring between 5th and 6
th

week of intra uterine life-the time of
segmentation-may lead to scoliosis.

4. 4
1. Right thoracic
90% of thoracic curvatures
are to the right
2. Right thorocolumbar
3. Left lumbar
4. Double major-S curve
Most Common Forms

5. Some Examples…

6. CLASSIFICATION
•FAILURE OF FORMATION.
Partial-Wedge vertebra.
Complete-Hemi vertebra.
•FAILURE OF SEGMENTATION.
Unilateral-Unilateral unsegmented bar.
Bilateral-Block vertebra.
•Miscellaneous.

7. TYPES

8. FAILURE OF FORMATION
•Partial unilateral failure of formation produces a
wedge that contains two pedicles, although one of
them will be hypoplastic.
•Hemivertebra consisting of half the vertebral
body, a single pedicle and a hemilamina.
•When present in thoracic vertebra, hemivertebra
are usually accompanied by extra rib.

9. Hemivertebra
•FULLY
SEGMENTED
•SEMISEGMENTED
•INCARCERATED
•NONSEGMENTAL

10. FULLY SEGMENTED
•A fully segmented type has the highest likelihood
of progressive deformity because it is separated
from the adjacent vertebra by end plates and
intervertebral disc.
•This readily apparent deformity is best treated
surgically at an early age before the compensatory
curve is fixed.
•The hemivertebra is always located at the apex of
scoliosis.

11. SEMISEGMENTED
•It is separated from one adjacent vertebra
by a normal vertebral growth plate and disc
but is fused to the adjacent vertebra.
•It can induce a slowly progressive scoliosis.
•Treatment is necessary if deformity is
progressive.

12. NON SEGMENTED
•It is fused to both adjacent vertebra and
therefore has no end plate and disc.
•It does not cause any spinal deformity.

13. INCARCERATED
•It is more ovoid in shape and smaller than a
fully segmented vertebra.
•The vertebra above and below compensate
for this vertebra and as a result there is
minimal scoliosis if any.

14. FAILURE OF SEGMENTATION
•Defects of segmentation result in a bony bar or
bridge between two or more vertebra, either
unilaterally or involving the entire segment.
•Circumferential failure of segmentation leads to a
block vertebra.
•This does not cause any angular or rotational
deformity but to some loss of longitudinal growth.

15. DEFECT OF SEGMENTATION
•A unilateral failure of
segmentation of two
or more vertebra is the
most common type
•Usually a bar of bone
fuses the disc space,
pedicle, facet joints on
one side of the spine,
precluding the growth
on the concavity.

16. •Patients with unilateral
failure of segmentation
with one or two
hemivertebra on the
opposite convex side of the
curve has worst prognosis.
•Curve of this kind present
in thoracolumbar can reach
50 * before two yrs.

17. NATURAL HISTORY
•The rate of deterioration and the ultimate
severity of the curve depends on both the
type of anomaly and the site at which it
occurs.
•The most progressive of all anomalies was a
concave,unilateral, unsegmented bar with a
convex hemivertebra.

18. •Second in severity was a unilateral
unsegmented bar,and next was a double
convex hemivertebra.
•For each type of anomaly the rate of
deterioration will be increasing in the order
of thoracic,thoracolumbar,lumbar.
•The rate of deterioration of curve is not
constant, but if the curve is present before
the patient is 10 years of age,it usually
increases,especially during adolescent
growth spurt.

19. DISEASE PROGRESSION
Block & wedge vertebrae < 1 degree/year
Hemivertebrae 1 to 2.5 degrees/year
Double hemivertebrae 2 to 5 degrees/year
Unilateral unsegmented bars with
contralateral hemivertebrae
Up to 10 degrees/year

20. •The deformity produced by a failure of
formation is much more difficult to predict
than that caused by failure of segmentation.
•A hemivertebra produces scoliosis through
an enlarging wedge on the affected side of
the spine ,whereas a unilateral unsegmented
bar retards growth on affected side.

21. •The growth imbalance in patients with
hemivertebra is not as severe as in those
with unilateral unsegmented bars.
•An-incarcerated hemivertebra-which exist
tucked into the spine between adjacent
normal vertebrae without causing a
corresponding deformity.

22. •Analyzing of the growth status is the most
important factor in predicting progressing
of the deformity.
•Analysis potential growth on either sides of
the curve will help with the prognosis.
•For eg, if normal convex growth is expected
& deficient concave growth is likely, major
deformity will occur.

23. •However if growth is deficient on both the
convex & concave sides, progressive lateral
deformity may not occur.
•If both sides are deficient in growth
potential over many levels, shortening of
the trunk may occur without lateral
curvature.

24. Thank u