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spine deformities recognition and evaluation1

deformities of the spine how to evaluated

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spine deformities recognition and evaluation1

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  1. Spine Deformities Recognition and Evaluation Dr. Bahaa Ali Kornah Prof.. Of Orthopedic Al-Azhar University Cairo - Egypt

  2. السلام عليكم ورحمة الله وبركاته bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  3. Deformities • Types • Static • Progressive bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  4. Deformities • Site at Bone short bone Bending Mal - Alignments Joints defect articular surface ligaments laxity osteoligamentous structures bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  5. Deformities • Postural deformities Deformity correct by voluntary effort • Structural deformity Deformity can not correct by voluntary effort due to anatomical structures changes + progressive • Fixed deformity Joint is deformed and immobile bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  6. Adult SpinalDeformity Quality of Life Affected • Functional limitations • Increased pain • Use of analgesics Baldus et al. Spine 2008 bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  7. Adult SpinalDeformity Psychological Effect • Social Stigma • Depression • Anxiety Beven et al. Spine, 2003 bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  8. Spinal Deformity • Coronal plan • Sagittal plane • Axilla plane bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  9. Ideal spinal alignment allows a standing posture with minimal muscular energy expenditure. • This is accomplished through a complex relationship between the • physiologic curvatures of the spine, • the morphology of the pelvis, and • the musculature of the axial and appendicular skeleton. (Schwab F, et al. Spine2010) (Bhalla A, et al. Seminars in Spine Surgery 2015) bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  10. NORMAL SPINE ALLIGNMENT • FRONTAL PLANE =CORONAL STRAIGHT • LATERAL PLANE= SAGITTAL • Cervical lordosis (≈30°) • Thoracic kyphosis (10°-40°) • Lumbar lordosis (40°-60°) bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  11. C7 – Prom. Spinous Process • T3- Level with Medial Scapular Spine • T7 – Inferior angle of scapula • L2 – Lowest Rib • L4 – Iliac Crest bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  12. Gravity line of human body AND the plumb line, bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  13. Postural Alignment • 2 naturally occurring curves • LORDOTIC (in lumbar region) • KYPHOTIC (in upper thoracic lower cervical regions) • Abnormalities -- accentuated vertebral curves bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  14. CSVL= central sacral vertical line bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  15. Spinal Deformity • Sagittal plane deformity • Coronal plane deformity • Axial plane deformity • Spinopelvic balance • Uniplanar + in one direction • Two planer deformity • Rotational deformity • Combined bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  16. Spinal Deformity • Scoliosis • 3-dimensional deformity affecting all 3 planes • Can be difficult to visualize with 2-dimensional radiographs • Kyphosis • Deformity affecting the sagittal plane • Neuromuscular • Results from neurologic or muscular diseases, such as cerebral palsy, muscular dystrophy, or polio bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  17. Types of Deformity • Congenital • Idiopathic (80%) • Infantile (0-2 y) • Juvenile (3-9 y) • Adolescent (10-17 y) • Adult (>18 yo) • Neuromuscular (CP, DMD, SMA etc..) • Degenerative • Traumatic / infectious • Iatrogenic • Syndromic (ED, Marfans, PW, Down S etc.) bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  18. Adult spinal deformity (ASD) resulting in coronal and/or sagittal plane decompensation. • idiopathic scoliosis • de novo or degenerative curves (Savage JW, et al. Global Spine J 2014) bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  19. SPINAL DEFORMITY INADULTS • CLINICALPRESENTATION • PAIN • COSMETICDEFORMITY • NEUROLOGICSYMPTOMS • PULMONARY COMPROMISE • PROGRESSION bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  20. DEFORMITY • Clinical • Radiology bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  21. Evaluation of patient withASDClinical examination ofspine bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  22. Side Front Cervical (Lordosis) Inspection Thoracic (Kyphosis) Lumbar (Lordosis) bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  23. A. Physical: • Posture: • Splinting • Body language • Gait: • Antalgia • Heel / Toe pattern • Trendelenburg • Musculoskeletal: • ROM • Leg length • Vascular • Atrophy bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  24. Back: • Inspection • Palpation • ROM • Scoliosis • Neurological: • Sensation • Motor • DTRs • Abdomen: • Presence of masses • Rectal if indicated: • Evaluation of sphincter tone bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  25. Gait bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  26. Inspection • Standing • Look from theside • normalspine • cervicallordosis • thoracickyphosis • lumbarlordosis bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  27. Kyphos and kyphosis • A Kyphosis is a posterior convexity ofthe spinal column • Smooth (paralysis, senile osteoporotic ,collapseof several vertebrae or Scheuermann’s disease • Angular TB bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  28. Increased kyphosis (posterior convexity of the spine) • senile kyphosis (with osteoporosis, osteomalacia or pathological fracture) • Scheuermann’s disease (osteochondritis involving one or more of the vertebrae) • ankylosing spondylitis bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  29. Gibbus (angularkyphosis) • fracture • tuberculosis of thespine • congenitalabnormality bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  30. Kyphosis bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  31. ThoracicKyphosis • exaggerated thoracic curve • occurs more frequently than lordosis • mechanism -- vertebra becomes wedge shaped • causes a person to “hunch over” bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  32. Kyphosis • aka “Swimmer’s Back” • develops in children swimmers who train with an excessive amount of butterfly • also seen in elderly women suffering from osteoporosis bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  33. bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  34. bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  35. Lordosis • A lordosis is a posterior concavity of the spinal column, often in the lumbar region. • Spondylolisthesis. • Pregnancy • Compensatory lordosis may be necessary to maintain balance. bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  36. . Lumbar curvature • flattening or reversal of lumbar lordosis : • prolapsed intervertebral disc • osteoarthritis of the spine • infection of vertebral bodies • ankylosing spondylitis • increase in lumbar lordosis • may be normal (esp. in pregnant women) • spondylolisthesis • secondary to increased thoracic curvature or to flexion deformity of the hips bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  37. Lumbar Lordosis • exaggeration of the lumbar curve • associated w/weakened abdominals (relative to extensors) • characterized by low back pain • prevalent in gymnasts, figure skaters, swimmers (flyers) bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  38. Look from behind = posterior • listing of trunk (due to muscle spasm) • Scoliosis (lateral curvature of spine) • postural : scoliosis disappears with forward flexion of the spine • structural : scoliosis persists with forward flexion of the spine and a rib hump presents • Shoulder tilt • Pelvic tilt bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  39. Skin changes over the spine • hair tuft (spina bifida) • sinus • color changes or pigmentation (neurofibroma) • scar • Swelling • Prominent crease of the trunk • Wasting of paraspinal muscles, glutei, hamstrings and calf muscles bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  40. bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  41. bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  42. bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  43. Scoliosis . bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  44. Scoliosis • lateral deviation of the spinal column • can be a ‘C’ or ‘S’ shape • involves the thoracic and/or lumbar regions • associated w/disease, leg length abnormalities, muscular imbalances bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  45. Scoliosis • more prevalent in females • cases range from mild to severe • small deviations may result from repeated unilateral loading (e.g. carrying books on one shoulder) bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  46. bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  47. SaggitalImbalance bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  48. Feel= Palpation • In the midline andlaterally. • The vertebral spinous processes • Interspinal ligaments • The muscles on each sideof the spine should also be palpated forspasm. bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  49. Palpation bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

  50. bahaa Kornah- Al-Azhar UN.- Cairo-EGYPT

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