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SCOLIOSIS (TREATMENT (RISSER (RISSER 0 – 3 (SCOLIOSIS OF LESS THAN 25…
SCOLIOSIS
TREATMENT
IDIOPATHIC SCOLIOSIS
- SERIAL FOLLOW – UP EVALUATION EVERY SIX MONTH
- BRACING
- SURGICAL TREATMENT
- DEPENDS ON THE AGE OF THE CHILD AND THE MAGNITUDE OF THE SCOLIOSIS
RISSER
- WHEN RISSER STAGE IV IS REACHED SPINAL GROWTH IS COMLETE
RISSER 0 – 3
- SCOLIOSIS OF LESS THAN 25 DEGREE – NO ACTIVE TREATMENT IS NEEDED. A FOLLOW-UP RADIOGRAPH SHOULD BE OBTAINED EVERY 6 MONTH TILL GROWTH IS COPLETED
- AN INCREASE OF THE SCOLIOSIS MORE THAN 25 (25 – 40 DEGREE), THE USE OF THORACOLUMBAR SACRAL ORTHOSIS OR BRACE IS INDICATED TO HOLD THE CURVE IN STRAIGHTER POSITION UNTIL GROWTH IS COMPLETED
- IF THE SCOLIOSIS PROGRESS PAST 40 DEGREE SURGICAL TREATMENT IS NEEDED
- PREVENT FURTHER PROGRESSION
-MILWAUKEE BRACE
-BOSTON BRACE
RISSER 4 - 6
- SCOLIOSIS OF LESS THAN 40 DEGREE AND SPINAL GROWTH IS COMPLETED– NO ACTIVE TREATMENT IS NEEDED. A FOLLOW-UP IN 1 YEAR.
- IF THE SCOLIOSIS PROGRESSES PAST 40 DEGREE SURGICAL TREATMENT IS NEEDED
-
SURGICAL TECHNIQUES
- POSTERIOR SPINAL INSTRUMENTATION
-HARRINGTON SYSTEM
-LUQUE SYSTEM
-COTREL – DUBOUSSET SYSTEM
- ANTERIOR SPINAL INSTRUMENTATION
-DWYER
-ZIELKE
-HOPF
based on Cobb angle
- <25°: observe for changes with serial radiographs
- more than 25° or progressive: bracing (many types) that halt/slow curve progression but do NOT reverse deformity
- more than 45°, cosmetically unacceptable or respiratory problems: surgical correction (spinal fusion)
DIAGNOSIS
PHYSICAL EXAMINATION
-
UNEQUAL SHOULDER POSITION
UNEQUAL SCAPULAR POSITION
ASYMMETRY IN THE WAIST AREA
THE LEVEL OF ILIAC WINGS
-
DIFFERENTIAL DIAGNOSIS
-
MRI: NEUROFIBROMATOSIS, INTRASPINAL ANOMALIES
ETIOLOGY
- IDIOPATHIC SCOLIOSIS / 80% /
- CONGENITAL SCOLIOSIS
- NEUROMUSCULAR SCOLIOSIS ( cerebral palsy, spina bifida )
- MUSCULAR SCOLIOSIS ( muscular dystrophy)
- CONGENITAL SPINAL ANOMALIES ( syryngomyelia, dysraphism)
- POSTTRAUMATIC SCOLIOSIS
- LATERAL SPINAL CURVATURE LARGER THAN 10°
- more frequent and more severe in females