Scoliosis basics, classification

definition, classification, pathophysiology of scoliosis

1. SCOLIOSIS Dr. SUSHIL KUMAR NAYAK DNB PGT 1Y. PM&R

2. ANATOMY DEFINITIONS TYPES OF PATHOLOGICAL CURVES ETIOPATHOGENESIS TYPES OF SCOLIOSIS

3. BODY PLANES

4. Three columns for the price of one

5. ANATOMY

6. DEFINITIONS The term scoliosis is derived from Greek word – skolio meaning any bend or twist. Galen defined it as abnormal curve in coronal plane. Scoliosis is a lateral curvature of the spine usually with rotational elements.

7. PATHOLOGICAL SPINAL CURVES The Scoliosis Research Society (SRS)has defined a medically significant frontal plane curve(scoliosis)as any curve which is greater or equal to 10⁰ with or without a rotatory component.

8. PLUMB LINE The curve in sagittal plane is less settled. The spine is balanced in the sagittal plane along a plumb line dropped from the centre of C7 to the sacral promontory..

9. Other terminologies Kyphosis is derived from Greek word “ kuphos ” meaning bend forwards or humped. Galen coined the term kyphosis as any sagittal curve having posterior vertex.. Lordosis Greek word “ lordós ”   is bending backwards It is used for anterior vertex in any sagittal curve..

10. According to Scoliosis Research Society (SRS): Normal thoracic kyphosis ranges 20⁰ to 50⁰. Normal lumbar lordosis ranges 31⁰ to 79⁰.

11. Abnormal kyphosis:- H yperkyphosis (round back) H ypokyphosis (flat back) Abnormal lordosis :- H yperlordosis ( swayback) H ypolordosis (flat back)

12. HUMP BACK (GIBBUS) DOWAGER ‘S HUMP

13. Primary curve -earliest curve to appear. If 3 curves: middle one usually primary. If 4 curves: middle 2 are usually primary. Secondary or compensatory curve -curve which develops above or below the primary curve in an effort to balance the spine.

14. Decompensated curve- compensatory curve doesn’t fully balance the primary one. Overcompensated curve-compensatory curve more than primary curve. Major curve-largest structural curve. Minor curve-smallest curve. Double major curve-scoliosis with two structural curves.

15. Apical vertebra - most deviated vertebra from the vertical axis of the patient. End vertebra - the uppermost /the lowermost vertebra whose superior surface or inferior surface respectively tilts maximally towards the concavity of the spine.

16. Cervical C1-C6 Cervicodorsal C7-T1 Thoracic T2-T11 Thoracolumbar T12-LI Lumbar L2-L4 Lumbosacral L5-S1 APICAL VERTEBRA CURVES

17. CLASSIFICATION OF SCOLIOSIS Scoliosis is broadly divided into structural or non-structural. Structural variety is not correctable completely. Instead non-structural is correctable fully.

18. STRUCTURAL TYPES

19. IDIOPATHIC TYPES Infantile ( › 3 yrs ) Resolving Progressive Juvenile (3-10 years) Adolescent (10 years to 18 years)

20. NEUROMUSCULAR TYPE Neuropathic U pper motor neuron Cerebral palsy Spinocerebellar degeneration Friedreich’s disease Charcot-Marie-Tooth disease Roussy -Levy disease Syringomyelia Spinal cord tumor Spinal cord trauma Other Lower motor neuron Poliomyelitis Other viral myelitidies Traumatic Spinal muscular atrophy Werdnig -Hoffman Kugelberg-Welalander Myelomeningocoele (paralytic) Dysautonomia (Riley-Day) Other Myopathic Arthrogryposis Muscular dystrophy Duchenne ( pseudohypertrophic ) Limb-girdle Facioscapulohumeral Fiber -type disproportion Congenital hypotonia Myotonia dystrophica Other

21. CONGENITAL SCOLIOSIS Failure of formation(type 1) Wedge vertebra(partial) Hemivertebra (complete):- segmented semisegmented Incarcerated nonsegmented Failure of segmentation(type2) Partial ( unsegmented bar) Complete(Bloc vertebra) Mixed(type3)

22. Neu rofibromatosis Mesenchymal disorders Marfan’s Ehlers- Danlos Others Rheumatoid disease Trauma Fracture Surgical Postlaminectomy Postthoracoplasty Irradiation Extraspinal contractures Post-empyema Post-bums O steochondrodystrophies Diastrophic dwarfism Mucopolysaccharidoses (for example, Morquio’s syndrome) Spondyloepiphyseal dysplasia Multiple epiphyseal dysplasia Other Infection of bone Acute Chronic Metabolic disorders Rickets Osteogenesis imperfecta Homocystinuria Others Related to lumbosacral join t Spondylolysis and spondylolisthesis Congenital anomalies of lumbosacral region Tumors Vertebral column Osteoid osteoma Histiocytosis X Other Spinal cord

23. NONSTRUCTURAL TYPES Postural scoliosis Hysterical scoliosis Nerve root irritation Herniation of nucleus pulposus Tumors Inflammatory causes Related to leg length discrepancy Related to contractures about the hip

24. PATHOPHYSIOLOGY OF SCOLIOSIS

25. GENETICS Notch signaling pathway and its interaction with FGF & Wnt signaling in the process of somitogeneis in congenital scoliosis. CHD7 gene on 15q26.1 chromosome is responsible for idiopathic scoliosis .( kulkarni et al)

26. References: Delisa’s PM&R Rothmore’s “The Spine” David J.Magee’s “Orthopedic physical assessment”

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