3/29/99

Orthopedics

Scoliosis

· Lovett—lateral curvature of the spine, along w/rotation—transient or pathological

· Majority are idiopathic

· Strong hereditary tendencies

· Major alterations of structure and mobility

· Affects organs of ribcage—bending to the left >50°(cardiovascular and pulmonary compromise (heart, aorta, lung)

· If bent to the right, organs okay to function

· Caillet—scoliosis in spine for potential for continued growth must be considered for curve growth

· Tx: spinal manipulation and lateral electric surface stimulation during sleeping

· Some are do to congenital conditions

· If curve progresses 1°/month, or is >50° surgical correction is warranted

· At the end of 3 months, re-evaluate if no change, refer out

· Slow progression curves are the ones that we can treat successfully

· Osseous anomalies—wedge vertebrae—cannot treat, refer out

· Juvenile and adolescent can treat

· Flexibility is important for treatment

· Full spine x-ray p®a

· Lumbar spinous process goes left if bend left

· Thoracic spinous process goes to if bend left

· Apex vertebra—most rotated or most laterally deviated

· Cobb method—most reliable method for measuring scoliosis

· Look for lowest involved vertebra and draw parallel line from inferior vertebra end plate

· From the most superior involved vertebra, draw parallel line from superior vertebra end plate

· Draw perpendicular line from both so they intersect and measure the angle

· Lumbar curve can cause problems anywhere in the spine including a headache

· Rib involve, curve to right, rib hump on right, vertebral body rotation side

· Assessing vertebra is Nash and Moe—ID pedicle shadows

· Shift to convex side

· Spinous process to the concavity

· Lateral bending films and look at ° of pedicle rotation

· A little subjective depending upon how the person is bending—not very consistent

· Simple or Acute--antalgic sign—spinous process in mid line—history of lifting something heavy, disc bulge—has not been there long

· Chronic or rotatory--spinous process into concavity, pedicle into convexity

Treatment

1. always stand on the side of the convexity

Protocol

1. new patient w/full work up: x-rays 16° curve

· 3x's a week for 2-3 wks

2. at 3 months—re-evaluate w/ x-rays—if have progressed 5° or more refer out

· variance could be +/- 3°

· very little change—continue to treat

3. exercises—William's exercises—pelvic tilt exercises, increases flexibility of abdominal muscles—also do extension type muscle which increases strength of paraspinal muscles and lateral bending—LESS put pads on side of concavity to contract those muscles