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DEFINITION
NATURAL HISTORY / PREVALENCE/ INCIDENCE/
ETIOLOGY
DIAGNOSIS
TREATMENT
COMPLICATION
DEFINITION SCOLIOSIS - AIS
3 dimensional deformity
Sagital plane
deformation Frontal plane
Transverse plane
- Summerwill - Quo
e - Chue
- Dickson
RECENT STUDIES
Porter
- Studies 36 skeleton 40% probable IS
2000
- SC short
- Posterior element tethered
- V.B growth (+)
- Lordotic + rotate
Schmitz,
- MRI studies
2001
- MR image do in supine
- Sagital cobb measured T4 – T12
- Group S Sagital cobb’s 130
- Group N Sagital cobb’s 230
- IS < N
- Relative
lordosis
RECENT STUDIES
Progressive deformation
(Heuters – Volkmann’s postulate)
CONSENSUS
CONSENSUS
Deformity progressiveness
(Heuters-Volkmann’s postulate)
DIAGNOSIS
History
Physical Examination
Diagnosis Radiographic examination /
evaluation
Neurological examination
DIAGNOSIS
History taking
- what - patient and family complain
- whom - deformity is detected
- where - what level
- when - age >
- why and how - treatment
Application of Scoliometer
Walking Gait
Normal
Abnormal
Motor Power
DIAGNOSIS
Radiographic Examination
1. Scoliosis Programm
- AP / lateral (standing)
- AP / Bending - supine
- Pelvic
3. Traction X Ray
Radiographic examination
Push prone AP
Correctability
Flexibility
Push - Prone
DIAGNOSIS
Traction - supine
RADIOGRAPHIC FACTOR
RADIOGRAPHIC FACTOR
DIAGNOSIS
DIAGNOSIS
End Vertebrae (EV) Most tilted
Least rotation
Least horizontal
to where tilted
Neutral Vertebrae
1st non rotated at the caudal and cranial end of curves
Stable Vertebrae
vertebrae with in curve located by CSVL
Predictive UIV and LIV
Stable Vertebrae
Neutral Vertebrae
DIAGNOSIS
a. Degree of Curve
b. Operative case King and Moe
Lenke
Classification - Principle basic Management / Treatment
strategy
Degree of Curve - Cobb
< 100 Observation & routine screening
100 - 200 observation & maintain + scoliosis exercise
200 - 300 scoliosis exercise + swimming
300 - 400 bracing + observation
400 - 500 bracing treatment + PE/ Swimming +
intensive observation
> 500 surgery
BRACING
BRACING
BRACING
BRACING
BRACING
BRACING
TREATMENT
Progressiveness and Management
What the meaning of observation
Technical evaluation
Follow up observation:
1. routine - fail
2. > 500
3. Skeletal Maturity / Peak Bone Velocity
4. Risser
5. Progressiveness
6. Mental and Self Body image (rejection with body
contour / posture)
SURGERY
Devices / Instrument
1960 1. Harrington
2. Luque
3. Harry - Lucky
4. TSRH/Synergy/ CD Instrument
5. Pedicle Screw Rod
Modification - Hook
- Hook wire
Hybride
- Hook Screw
sagital and coronal balance
Surgery / surgical treatment
- Selection case
- Multiply observation / non operative
treatment (criteria / parameter)
- Non operative questionable (failed ?)
- Case assessment
Radiographic assessment
1. Level of Curve
2. Degree of Curve
3. Sagital alignment
4. Lumbar modifier
2 dimensional King and Moe 1-5
Classification
GADO-GADO
Technique
1. Approach : - anterior
- posterior
- combined
2. Assestment : Open
Closed
Surgical Indication
> 50 percent : Maturity (+)
Menarche (+) Timing
Risser ≥ 2
Peak bone level Stop
Progressive
Pain
Effort to breath (lung compliance)
Comorbid
COMPLICATION
EARLY
1. Bleeding
2. Infection
3. Neurologic complication
LATE
1. crankshaft phenomenon
2. coronal decompensation
Addition of surgical therapy of AIS
- Spinal balance
sagital
- Spinal fusion
axial
7. Major Minor
- Informed Concents
- It is mandatory to help patients understand principle of
surgical treatment scoliosis name of operation
Surgical Planning Strategy
Scoliosis reconstruction + posterior instrumentation (author
preferred)
- Reconstruction technique : Incision
- Distraction (H) Bone grafting arthrodesis
- Translation (L) - source of bone graft iliac graft (golden
- Distraction translation (H-L) standard)
- CD Instrumentation allograft
- Pedicle Screw bone substitution
- Iliac harvest(painful ?)
- Posterior instrumentation
- Harrington (original)
- Luque
- Harry Lucky
- CD/ CD Horizon
- TSRH
- pedicle screw Rod
- UI system (local mode)
Modification
- Hook Wire
- Hook Screw
- Screw + wire
Post operative planning
spinal deformity
Cobb’s degree
Non <100 Operative
Operative
100 - 200
- observatio
n 200 - 300
- medical 300 - 400
advices
- Scoliosis
exercise borderline
- Bracing (400 - 500)
Patient –
observatio
doctor
ns relationship
progresivene
ss
Prevalence/Incidence/Consideration/Diagnosis
Complication
early late
- Bleeding - Crankshaft
- Shock phenomenon
- Neurological - Coronal
deterioration decompensation
- Infection
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