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 Dr. Theodoros B Grivas MD, PhD Traumatology & Orthopaedic Department, "Tzaneio" General Hospital of Piraeus NHS, Tzanni & Afendouli str, 18536, Piraeus, Greece, tgri69@otenet.gr
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) created the normal spine articulated & mobile
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) created the normal spine articulated & mobile
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany)
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany)
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) SRS Terminology Committee and Working Group on Spinal Classification Revised Glossary of Terms By the Working Group on 3-D Classification (Chair Larry Lenke, MD), and the Terminology Committee, March 2000 http://www.srs.org/professionals/glossary/srs_revised_glossary_of_terms.htm Scoliosis is a lateral curvature of the spine http://www.srs.org/patient_and_family/ Idiopathic Scoliosis means Cobb angle > 10 o Structural curve 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
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) http://www.scoliosisjournal.com/content/pdf/1748-7161-5-23.pdf
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Definitions
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Types of curves 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 Structural /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 Compensatory a minor curve above or below a major curve that may or may not be structural
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Chronologic definition of idiopathic scoliosis presentations: Α. Infantile: < 3 yrs of age 1. Resolving (improvement) 2. Progressive (deterioration worsening ) Β. Childhood: 3 10 yrs of age C. Adolescent: 10 yrs of age until physis closure 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: 36-49. D. Adult: Adult Onset Scoliosis : from 18 yrs of age Early onset scoliosis: before age of 10 years Late onset scoliosis: typical adolescent scoliosis
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany)
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) What is AIS? 3-D deformation A scenario of asymmetries not only of the spine!
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) The elements of the deformity
Asymmetries in Thorax - ribs Spine - vertebrae pelvis 11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany)
Asymmetries in pelvis 11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) INGELMARK BE, LINDSTROM J. Asymmetries of the lower extremities and pelvis and their relations to lumbar scoliosis. A radiographic study. Acta Morphol Neerl Scand. 1963;5:221-34. Burwell et al RG, Aujla RK, Freeman BJ, Dangerfield PH, Cole AA, Kirby AS, Pratt RK, Webb JK, Moulton A. Patterns of extra-spinal left-right skeletal asymmetries in adolescent girls with lower spine scoliosis: relative lengthening of the ilium on the curve concavity & of right lower limb segments.stud Health Technol Inform. 2006;123:57-65.
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Asymmetries in Femur Anteversion
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany)
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Infantile scoliosis facial asymmetries plagiocephaly (86%) Rock and Baker, Angle Orthod, 1972
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany)
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Clinical appraisal steps of suspicion of structural scoliosis
AIS - The clinical deformity in frontal plane sagittal plane hypokyphosis transvers plane rotation
AIS - The clinical deformity frontal plane posterior frontal plane anterior frontal plane posterior
AIS - The clinical deformity frontal plane posterior frontal plane anterior sagittal plane hypo-kyphosis
AIS - The clinical deformity Rib hump
The clinical deformity
The clinical deformity
AIS - The clinical deformity
11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) there is no automatic parthenogenesis of structural scoliosis w/ 10 o of Cobb angle & more but it starts from 1 o, 2 o, 3 o also We can t 100%predict which curve will progress unless we follow the patients We must list the signs that could establish the diagnose to a specific pathology & finally to put the diagnose of Idiopathic Scoliosis by rejecting other pathologies
The clinical appraisal Forward bending test Adam s 1865
The clinical appraisal ATI - ATR Angle Trunk Inclination / Rotasion
The clinical appraisal Forward Bending Test (FBT) Adam s 1865
The clinical appraisal inclinometer (scoliometer) with the trunk flexed to the horizontal, ATR is the angle between the horizontal & the plane across the back at the greatest elevation of a rib prominence or lumbar prominence, as measured by an inclinometer (scoliometer)
Screening techniques Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece The Bunnel scoliometer Posture Evaluation Tools - Scoliometers The Pruijs scoliometer A special instrument - scoliometer designed for the assessment of the height of rib prominence-hump
Screening techniques Posture Evaluation Tools - Scoliometers Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece rib hump Measurement, using the iphone and Scolioguage software in combination w/ the acrylic sleeve or w/out
Screening techniques The accuracy (intra- and inter-reliability) of the Scoliometer Grivas et al. Pediatric Rehabilitation, 2006 Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece
Study of trunk asymmetry in normal children and adolescents, Grivas et al 2006 36
Screening techniques FBT standing sitting mid-thoracic (T4 T8) thoracolumbar (T12 L1) lumbar (L2 L5) region
Screening techniques FBT standing sitting mid-thoracic (T4 T8) thoracolumbar (T12 L1) lumbar (L2 L5) region
Standing Scoliometer Sitting 80 70 90 80 60 70 50 60 T 40 30 number of children 50 40 20 30 20 10 10 0 AGE<=7 7<=AGE<8 8<=AGE<9 9<=AGE<10 10<=AGE<11 11<=AGE<12 AGE>=12 0 AGE<=7 7<=AGE<8 8<=AGE<9 9<=AGE<10 10<=AGE<11 11<=AGE<12 AGE>=12 age 80 90 70 80 60 70 TL number of children 50 40 30 20 10 number of children 60 50 40 30 20 10 0 AGE<=7 7<=AGE<8 8<=AGE<9 9<=AGE<10 10<=AGE<11 11<=AGE<12 AGE>=12 0 age AGE<=7 7<=AGE<8 8<=AGE<9 9<=AGE<10 10<=AGE<11 11<=AGE<12 AGE>=12 age 80 90 70 80 60 70 L number of children 50 40 30 number of children 60 50 40 30 20 20 10 10 0 AGE<=7 7<=AGE<8 8<=AGE<9 9<=AGE<10 10<=AGE<11 11<=AGE<12 AGE>=12 0 AGE<=7 7<=AGE<8 8<=AGE<9 9<=AGE<10 10<=AGE<11 11<=AGE<12 AGE>=12 age age 39
Scoliometer in +1: Scoliometer readings from 1 to 6 to the right. -1: Scoliometer readings from 1 to 6 to the left. +2: Scoliometer readings 7 to the right. -2: Scoliometer readings 7 to the left. Sitting Standing T TL L T TL L Study of trunk asymmetry in normal children and adolescents, Grivas et al 2006 41
Screening techniques Detection of idiopathic scoliosis at an early stage the scoliometer reveals children w/ surface deformity. It does not reveal the IS per se the hump doesn't always disclose a spinal curve Grivas et al Scoliosis 2007
no scoliosis - straight spines w/ rib hump
no scoliosis - straight spines w/ rib hump The recommendation resulting from the above findings is that the specialist must follow an asymmetric child especially in the younger age group
11th International Conference on Conservative Management of Spinal Deformities 4th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Thank you for your attention