Idiopathic scoliosis Thriasio General Hospital

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1 3rd SOSORT Scientific Meeting Poznan, Poland, 2006 Idiopathic scoliosis Thriasio General Hospital Athens Greece basic nomenclature Dr. Theodoros B. GRIVAS, MD Orthopaedic & Spinal Surgeon

2 3rd SOSORT Scientific Meeting Poznan, Poland, 2006 Thriasio General Hospital Athens Greece als/glossary/gl ossary.asp

3 Idiopathic Scoliosis Thriasio General Hospital Athens Greece Definition: What is scoliosis? It is a 3-D deformity of the spinal column

4 rotation rotation is a rigid body movement which keeps a point fixed; unlike a translation. This definition is applicable both for rotations in a plane (two dimensions) and in space (three dimensions).

5 rotation Rotation as change in orientation. Rotation of a planar figure around a point Thriasio General Hospital Athens Greece

6 torsion torsion (mechanics) In solid mechanics, torsion occurs when an object is twisted or screwed around its axis. Torsion can be the result of an applied torque. It is a kind of shear stress. For circular sections, the shearing stress at a point on a transverse plane is always perpendicular to the radius to the point.

7 Idiopathic Scoliosis Definitions Organic (stractural) Non organic (funcional)

Idiopathic Scoliosis Types of curves Definitions Major the curve with the largest Cobb measurement on upright long cassette coronal x-ray of the spine Minor any curve that does not have the largest

8 Idiopathic Scoliosis Types of curves Definitions Major the curve with the largest Cobb measurement on upright long cassette coronal x-ray of the spine Minor any curve that does not have the largest Cobb measurement on upright long cassette coronal x-ray of the spine Stracural /organic a measured spinal curve in the coronal plane in which the Cobb measurement fails to correct past zero on supine maximal voluntary lateral side bending x-ray Compasatory a minor curve above or below a major curve that may or may not be structural

9 Scoliosis classification Chronologic definition of idiopathic scoliosis presentations: Ι) Idiopathic Definitions Α. infantile: less than 3 years of age 1. Resolving (improvement) 2. progressive (deterioration - worsening ) Β. childhood: 3-10 years of age C. Adolescent: 10 years of age to the age of epiphysial fusion D. Aduld Onset Scoliosis from age 18 and beyond Early onset scoliosis: before age of 10 years James JI: Idiopathic Scoliosis: THe Prognosis, Diagnosis, and Operative Indications Related to Curve Patterns and the Age of Onset. J Bone Joint Surg 1954; 36B: Late onset scoliosis: typical adolescent scoliosis

10 Idiopathic Scoliosis Infantile: 0-3 years of age

11 Idiopathic Scoliosis Childhood 3-10 years of age

12 Idiopathic Scoliosis Ήβη μέχρι πλήρη σκελετική ωρίμαση

13 IS Curve types related to the apical vertebra position Thriasio General Hospital Athens Greece

14 IS Curve types Thriasio General Hospital Athens Greece

15 Thriasio General Hospital Athens Greece Idiopathic Scoliosis Elements of the deformity

16 Idiopathic Scoliosis Thriasio General Hospital Athens Greece

17 Idiopathic Scoliosis Thriasio General Hospital Athens Greece

18 Idiopathic Scoliosis Thriasio General Hospital Athens Greece

19 Clinical deformity in frontal plane saggital plane hypokyphosis transverse plane, rotation

20 Clinical deformity Adolescent frontal frontal plane saggital plane frontal frontal plane anterior posterior hypokyphosis

21 Clinical deformity Thriasio General Hospital Athens Greece

22 Clinical deformity

23 Clinical deformity Forward Bending Test (FBT) Adams 1865 Thriasio General Hospital Athens Greece

24 Clinical deformity ATI - ATR Thriasio General Hospital Athens Greece Angle Trunk Inclination / Rotasion

the horizontal and the plane across the back at the greatest elevation of a

25 Clinical deformity Thriasio General Hospital Athens Greece inclinometer (scoliometer) with the trunk flexed to the horizontal, the angle between the horizontal and the plane across the back at the greatest elevation of a rib prominence or lumbar prominence, as measured by an inclinometer (scoliometer)

26 Radiological assessment Thriasio General Hospital Athens Greece

27 Thriasio General Hospital Athens Greece

28 Cobb method Thriasio General Hospital Athens Greece

29 Radiological assessment

30 Rib Vertebra Angle (RVA) MEHTA, 1972 GRIVAS 1990 Thriasio General Hospital Athens Greece

31 Infantile IS Phase Ι Phase ΙΙ Rib Vertebra Angle (RVA) RVAD > 20º MEHTA, 1972

32 Radiological assessment Infantile: 0-3 years of age Scoliotic thorax Fannel shaped Normal thorax Barrel shaped

33 Apical vertebral Apical vertebral in a curve, the vertebra most deviated laterally from the vertical axis that does not passes through the patient's sacrum, i.e. from the central sacral line Thriasio General Hospital Athens Greece

34 Vertebral torsion (Perdiolle ( Perdiolle) Thriasio General Hospital Athens Greece

35 The Double Rib Contour Sign (DRCS) GRIVAS 2002 Stud Health Technol Inform. 2002;88: Thriasio General Hospital Athens Greece

36 Ossification of the epiphyseal ring Risser sign (1-5) (osification of the iliac apophysis) 36 Thriasio General Hospital Athens Greece

37 Risser sign: in the frontal plane x-ray of the pelvis, the state of ossification of the iliac apophysis used to denote the degree of skeletal maturity: 0-no evidence of ossification of the apophysis; 1-25% excursion; 2-50% excursion; 3-75% excursion; 4-100% excursion; 5-fusion of the apophysis to 37 the iliac crest

38 Radiological assessment King I King II King III King classification King IV King V

39 Radiological assessment Lenke, et al. JBJS,2001)

40 SRS Classification

41 Treatment

42 Treatment

43 Treatment modalities Observation (school screening) Conservative treatment Exercises Brace Surgical Treatment

44 School-screening Scoliometer > 7 ATI Follow up Treatment modalities Treatment modalities

45 exercises Indications for conservative management of scoliosis (guidelines) Treatment modalities Hans-Rudolf Weiss1*, Stefano Negrini2*, Manuel Rigo3$, Tomasz Kotwicki4$, Martha C Hawes5$, Theodoros B Grivas6$, Toru Maruyama7$, Franz Landauer8$ (SOSORT guideline committee) 1SOSORT senior board member, Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany 2 SOSORT senior board member, ISICO (Italian Scientific Spine Institute), Milan, Italy 5 SOSORT scientific advisor, University of Arizona, Tucson AZ 85721, USA 3 SOSORT senior board member, Instituto Èlena Salvá, Barcelona, Spain 4 SOSORT senior board member, University of Medical Sciences, Poznan, Poland 6 SOSORT senior board member, Orthopaedic Department "Thriasion" General Hospital, Magula, Athens, Greece 7 SOSORT senior board member, Department of Orthopaedic Surgery, Teikyo University School of Medicine, Kaga, Itabashi-ku, Tokyo , Japan 8 SOSORT senior board member, Landesklinik für Orthopädie, Müllner Hauprstr. 48, A Salzburg, Austria

46 exercises Treatment modalities

47 exercises Treatment modalities Treatment modalities

48 Types of Braces Treatment modalities According to SRS : Upon the brace extent on the body it is named using the initial of the anatomical areas in contact Cervical (C) Thoracic (T) Lumbar (L) Spinal (S) Orthosis (O) CTLSO

49 Types of Braces Treatment modalities a)extented up to the neck Milwaukee Schmidt) C.T.L.S.O. (Blount και C.T.L.S.O. b) sub-axilla axillar T.L.S.O. Boston brace c) Only in the thorax T.S.O. Derotation Thoracic Brace (DTB)

50 Treatment modalities

51 Treatment modalities

52 Treatment modalities AIS - Dynamic Boston Brace

53 Treatment modalities

54 Treatment modalities Childhood Idiopathic scolosis (CIS)

55 Thriasio General Hospital Athens Greece

56 Spinal Anchors Screws only (Se Il Suk) Thriasio General Hospital Athens Greece Hooks & screws Hooks only

57 Thank you Thriasio General Hospital Athens Greece

Dr. Theodoros B Grivas MD, PhD

Dr. Theodoros B Grivas MD, PhD 11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Idiopathic Scoliosis definitions, detection, clinical picture