3rd SOSORT Scientific Meeting Poznan, Poland, 2006 Idiopathic scoliosis Thriasio General Hospital Athens Greece basic nomenclature Dr. Theodoros B. GRIVAS, MD Orthopaedic & Spinal Surgeon
3rd SOSORT Scientific Meeting Poznan, Poland, 2006 Thriasio General Hospital Athens Greece http://www.srs.org/profession als/glossary/gl ossary.asp
Idiopathic Scoliosis Thriasio General Hospital Athens Greece Definition: What is scoliosis? It is a 3-D deformity of the spinal column
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). http://www.answers.com/rotation
rotation Rotation as change in orientation. Rotation of a planar figure around a point Thriasio General Hospital Athens Greece
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.
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 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
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: 36-49. Late onset scoliosis: typical adolescent scoliosis
Idiopathic Scoliosis Infantile: 0-3 years of age
Idiopathic Scoliosis Childhood 3-10 years of age
Idiopathic Scoliosis Ήβη μέχρι πλήρη σκελετική ωρίμαση
IS Curve types related to the apical vertebra position Thriasio General Hospital Athens Greece
IS Curve types Thriasio General Hospital Athens Greece
Thriasio General Hospital Athens Greece Idiopathic Scoliosis Elements of the deformity
Idiopathic Scoliosis Thriasio General Hospital Athens Greece
Idiopathic Scoliosis Thriasio General Hospital Athens Greece
Idiopathic Scoliosis Thriasio General Hospital Athens Greece
Clinical deformity in frontal plane saggital plane hypokyphosis transverse plane, rotation
Clinical deformity Adolescent frontal frontal plane saggital plane frontal frontal plane anterior posterior hypokyphosis
Clinical deformity Thriasio General Hospital Athens Greece
Clinical deformity
Clinical deformity Forward Bending Test (FBT) Adams 1865 Thriasio General Hospital Athens Greece
Clinical deformity ATI - ATR Thriasio General Hospital Athens Greece Angle Trunk Inclination / Rotasion
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)
Radiological assessment Thriasio General Hospital Athens Greece
Thriasio General Hospital Athens Greece
Cobb method Thriasio General Hospital Athens Greece
Radiological assessment
Rib Vertebra Angle (RVA) MEHTA, 1972 GRIVAS 1990 Thriasio General Hospital Athens Greece
Infantile IS Phase Ι Phase ΙΙ Rib Vertebra Angle (RVA) RVAD > 20º MEHTA, 1972
Radiological assessment Infantile: 0-3 years of age Scoliotic thorax Fannel shaped Normal thorax Barrel shaped
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
Vertebral torsion (Perdiolle ( Perdiolle) Thriasio General Hospital Athens Greece
The Double Rib Contour Sign (DRCS) GRIVAS 2002 Stud Health Technol Inform. 2002;88:38-43. 35 Thriasio General Hospital Athens Greece
Ossification of the epiphyseal ring Risser sign (1-5) (osification of the iliac apophysis) 36 Thriasio General Hospital Athens Greece
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
Radiological assessment King I King II King III King classification King IV King V
Radiological assessment Lenke, et al. JBJS,2001)
SRS Classification
Treatment
Treatment
Treatment modalities Observation (school screening) Conservative treatment Exercises Brace Surgical Treatment
School-screening Scoliometer > 7 ATI Follow up Treatment modalities Treatment modalities
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, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan 8 SOSORT senior board member, Landesklinik für Orthopädie, Müllner Hauprstr. 48, A- 5020 Salzburg, Austria
exercises Treatment modalities
exercises Treatment modalities Treatment modalities
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
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)
Treatment modalities
Treatment modalities
Treatment modalities AIS - Dynamic Boston Brace
Treatment modalities
Treatment modalities Childhood Idiopathic scolosis (CIS)
Thriasio General Hospital Athens Greece
Spinal Anchors Screws only (Se Il Suk) Thriasio General Hospital Athens Greece Hooks & screws Hooks only
Thank you Thriasio General Hospital Athens Greece