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Although it is a complex three-dimensional deformity, on an x-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line.Slide 3: Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosi s is a curve seen from the side in which the spine is bent forward. Lordosis is a curve seen from the side in which the spine is bent backward. People with scoliosis develop additional curves to either side, and the bones of the spine twist on each other like a corkscrew.What causes Scoliosis? : In most cases, the cause of scoliosis is unknown ( idiopathic ). This type of scoliosis is described based on the age when scoliosis develops. Infantile Idiopathic Scoliosis - i f the person is less than 3 years old Juvenile Idiopathic Scoliosis - develops between 3 and 10 years of age/onset of puberty Adolescent Idiopathic Scoliosis - over 10 years old or postpuberty ; most common What causes Scoliosis?Slide 6: There are three(3) other main types of scoliosis: Functional : the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back. Neuromuscular : there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely, or they fail to separate from each other.Slide 7: This type of scoliosis develops in people with other disorders including birth defects , muscular dystrophy , cerebral palsy , or Marfan's disease . If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis. * Marfan’s syndrome is a genetic disorder of the connective tissue. In people with Marfan syndrome, this "glue" is weaker than normal. This causes changes in many systems of the body, but especially the heart , eyes , and bones . They tend to be tall and thin with very long arms, legs, fingers, and toes. Often develop curves in their spines ( scoliosis ) or their chest bones. They also may be nearsighted and have other problems with their eyes. But the most serious thing about Marfan syndrome is what can happen with the heart.Slide 8: Degenerative : Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. Caused by changes in the spine due to arthritis . Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. Others : There are other potential causes of scoliosis, including spine tumors such as osteoid osteoma . This is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce the amount of pressure applied to the tumor.What are the symptoms of scoliosis? : Most common symptom - abnormal curve of the spine. Scoliosis may cause the head to appear off center or one hip or shoulder to be higher than the opposite side. If more severe, it can make it more difficult for the heart and lungs to work properly - cause shortness of breath and chest pain In most cases, scoliosis is not painful , but there are certain types of scoliosis than can cause back pain . What are the symptoms of scoliosis?How is scoliosis diagnosed? : Doctors use a medical and family history, physical exam, and tests when checking a person for scoliosis. An x ray of the spine can help the doctor decide if a person has scoliosis. The x ray lets the doctor measure the curve in degrees (such as 25 degrees) and see its location, shape, and pattern. How is scoliosis diagnosed?How is scoliosis treated? : Treatment for scoliosis is based on: The person's age How much more he or she is likely to grow The degree and pattern of the curve The type of scoliosis How is scoliosis treated?How is scoliosis treated? : There are three main categories of treatment: observation, bracing, and surgery Functional scoliosis is caused by an abnormality elsewhere in the body. this type of scoliosis is treated by treating that abnormality, such as a difference in leg length there is no direct treatment of the spine because the spine is normal in these people How is scoliosis treated?Slide 13: Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine. have the greatest chance for getting worse. observation and bracing do not normally work well Majority will eventually need surgery to stop the curve from getting worse.Slide 14: Idiopathic scoliosis - based on the age when it develops In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective Juvenile idiopathic scoliosis - has the highest risk for getting worse of all of the idiopathic types of scoliosis.Slide 15: Bracing can be tried early if the curve is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.Slide 16: Adolescent idiopathic scoliosis - is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve stays below 25 degrees, no other treatment is needed . If the curve is between 25-40 degrees, a brace may be recommended. If the curve is greater than 40 degrees, then surgery may be recommended.Summary (Treatment): Observation: The doctor will check every 4 to 6 months - if curve is getting better or worse. used for those who have a curve of less than 25 degrees and are still growing. Bracing: Doctors may advise wearing a brace to stop a curve from getting worse, may be used when: The person is still growing and has a curve of more than 25-30 degrees. The person is still growing and has a curve between 20 -29 degrees that is getting worse. Person has at least 2 years of growth remaining and has a curve that is between 20 -29 degrees. If a girl, she should not have started having her monthly periods yet. Summary (Treatment)Slide 18: Surgery: to correct a curve or stop it from getting worse when the person is still growing the curve is more than 45 degrees & the curve is getting worse. often involves fusing together two or more bones in the spine, doctor may also put in a metal rod or other device. These devices are called implants . They stay in the body and help keep the spine straight after surgery.Fusion Most scoliosis operations involve fusing the vertebrae. The instruments and devices used to support the fusion vary. In the fusion procedure, the surgeon will: Slice flaps to expose the backs of the vertebrae that lie along the curve. Remove the bony outgrowths along the vertebrae that allow the spine to twist and bend. Lay matchstick-sized bone grafts vertically across the exposed surface of each vertebra, being careful that they touch adjoining vertebrae. Fold the flaps back to their original position, covering the bone grafts. These grafts will regenerate, grow into the bone, and fuse the vertebrae together. : Fusion Most scoliosis operations involve fusing the vertebrae. The instruments and devices used to support the fusion vary. In the fusion procedure, the surgeon will: Slice flaps to expose the backs of the vertebrae that lie along the curve. Remove the bony outgrowths along the vertebrae that allow the spine to twist and bend. Lay matchstick-sized bone grafts vertically across the exposed surface of each vertebra, being careful that they touch adjoining vertebrae. Fold the flaps back to their original position, covering the bone grafts. These grafts will regenerate, grow into the bone, and fuse the vertebrae together.Slide 20: Minimally Invasive Thoracoscopic Surgery for Scoliosis In the VATS procedure, the patient is placed on his or her side. Several small incisions, termed portals, are made on the side of the chest wall and one lung is deflated (this is called single lung ventilation) to increase access to the thoracic spine. A thin telescope-like instrument with a tiny video camera and light at its tip (called an endoscope), is inserted through one of the incisions. This allows me to see video images of the spine "inside" the body on a computer monitor in the operating room. Small hollow tubes are then inserted through the other incisions. Using the video monitor as a guide, I then insert specialized surgical instruments through the portals to perform This adolescent girl had a 50° curvature treated by thoracoscopic technique resulting in excellent correction. Note the spontaneous correction of the un-operated lumbar curvature. Also note the small, well-hidden incisions associated with the procedure.Slide 21: About Other Treatments for Scoliosis So far, the following treatments have not been shown to keep curves from getting worse in scoliosis: Chiropractic treatment Electrical stimulation Nutritional supplements ExerciseIndications for recommending the use of orthoses include the following:: Pain relief Mechanical unloading Scoliosis management Spinal immobilization after surgery Spinal immobilization after traumatic injury Compression fracture management Kinesthetic reminder to avoid certain movements Indications for recommending the use of orthoses include the following:The use of an orthosis is associated with several drawbacks : : Discomfort Local pain Osteopenia Skin breakdown Nerve compression Ingrown facial hair in men Muscle atrophy with prolonged use Decreased pulmonary capacity Increased energy expenditure with ambulation Difficulty with transfers Psychological and physical dependency Increased segmental motion at the ends of the orthosis Unsightly appearance Poor patient compliance The use of an orthosis is associated with several drawbacks :Scoliosis Orthosis, Boston Back Brace : Scoliosis Orthosis , Boston Back Brace Purpose of the Device Provides corrective forces to the thoraco-lumbar spine Incorporates abdominal intercavity pressure to reduce lumbar lordosis Most commonly used for patients prior to skeletal maturity Indications Scoliosis for T8, L5 apex Excessive lumbar lordosis and associated conditionsLumbosacral Flexion-Extension Control Orthosis (Chairback): Lumbosacral Flexion-Extension Control Orthosis ( Chairback ) Purpose/Function of Device Lightweight spinal orthosis maintains spine in a neutral, stable position. Restrict trunk extension occuring in lumbar spine Increases intraabdominal pressure, thus lessen lordosisTLS F-E-L Control Orthosis (Knight-Taylor): TLS F-E-L Control Orthosis (Knight-Taylor) Indications : For the post-operative management Mild to Moderate sprains and strains at the Back bone, spinal column (Back bone) pain Greater tendency to limit rotation & lateral trunk motionSlide 27: scoliosis is not typically associated with back pain. In cases with back pain, the symptoms can be lessened with physical therapy , massage , exercises , yoga . These can help to strengthen the muscles of the back. They are not, however, a cure for scoliosis and will not be able to correct the abnormal curve.Slide 28: Scoliosis - Medications When back pain occurs in association with scoliosis, the pain may be caused by problems in a muscle, disc, facet, or nerve root, or by a tumor. It is not usually caused by the curve itself. Some people may use nonprescription medicines such as aspirin and ibuprofen to treat back pain. While these medicines may relieve symptoms of back pain temporarily, they do not heal scoliosis or back injuries, nor do they stop the pain from coming back.Is there a cure for scoliosis? : At this time, there is no cure for scoliosis. There are good treatment options There is no cure but the curvature can be either corrected or the progression of the curving can be halted. Treatments include physical therapy/stretches, brace treatment, or surgery. Surgery can correct the curve to some extent but not completely. Is there a cure for scoliosis?THE END: THE END You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.