*-*Physiology Presentation*-* SCOLIOSIS

GROUP MEMBER:•RASYIDAH•RAFI•MIZA•FADHLIN

History of Scoliosis

• The term scoliosis comes from a Greek word meaning "crooked.“

• The disease affects the spine, causing it to curve into an S-shape.

• The spine may also, in some severe cases, be rotated.

• The disease has existed for centuries, and with each passing century, human understanding and treatment for the condition has improved.

Classification of Scoliosis

Congenital scoliosis

Idiopathic scoliosis

Neuromuscular scoliosis

Postural scoliosis

Syndromic scoliosis.

Congenital scoliosis

• Congenital scoliosis means that the person affected is born with scoliosis.

• This type of scoliosis is caused by abnormality in one or more vertebrae which means they fail to form properly.

• This condition is obvious when seen on an X-ray or in operating room.

Idiopathic scoliosis

• Idiopathic scoliosis is the most common form of scoliosis. Idiopathic is defined as “of unknown cause”.

• Usually the person that has this type of scoliosis is living healthily and normally. The abnormality does not show on an X-ray or during direct observation in operating room.

• The occurrence is equal in female and male, but, however, severe idiopathic scoliosis is six to seven times more common in females.

Neuromuscular scoliosis

• Neuromuscular scoliosis affects people suffering from nervous system ailments such as poor muscle control, muscle weakness, or paralysis due to cerebral palsy, muscular dystrophy, spinal bifida or polio.

Postural scoliosis

• Postural scoliosis, also called hysterical scoliosis may result from pain as patient tends to tilt to relieve their pain.

• It can be solved by relieving the pain or by lying flat on a surface.

• In this condition, the vertebrae do not show any abnormality on an X-ray.

Syndromic scoliosis

• Syndromic scoliosis occurs in people with Marfan Syndrome.

Signs and symptoms of scoliosis

Uneven musculature on one

side of the spine

Uneven shoulder height

Uneven hips/leg lengths

Slow nerve action (in some cases)

Head is not centered directly above the pelvis

Uneven musculature on one side of spine

Uneven hip, shoulders

Head is not centered directly above the pelvis

Diagnosis,,, • A standard exam that is often used by pediatricians and in initial school

screenings is called the Adam's Forward Bend Test.• For this test, the patient is asked to lean forward with his or her feet together

and bend 90 degrees at the waist. The examiner can then easily view from this angle any asymmetry of the trunk or any abnormal spinal curvatures. It should be noted that this is a simple screening test that can detect potential problems, but cannot determine accurately the exact severity of the deformity.

• Once suspected, scoliosis is usually confirmed with an x-ray, spinal radiograph, CT scan, MRI or bone scan of the spine.

• The curve is then measured by the Cobb Method and is discussed in terms of degrees.

• Generally speaking, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment.

Adam’s Forward Bend Test

Causes of scoliosis

Genetics

Structural Elements of the Spine or muscle(connective tissue disorders, muscle disorders) related with the formation of the spine bones (vertebrae) or fused ribs during development in the womb or early in life.

Damaged of connective tissue- Marfan Syndrome

Pathophysiology of Scoliosis

• In most cases, scoliosis is painless. However, it can become more severe if left untreated, resulting in chronic back pain.

• In young children, severe cases can cause deformities, impair development and be life-threatening.

• It often worsens during children and teen period. Scoliosis patients who wear a back brace over an extended period of time can usually prevent further curvature of the spine.

Effects of scoliosis

Initial effec

t

• In children, does not cause any pain such as back pain.• Main symptoms are uneven shoulder blades and waist.• But, if not treated, it can become worse.

Arthritis

• Because the spine becomes abnormally curved side to side as a result of scoliosis, it can lead to the joints between the vertebrae becoming damaged.

• This can lead to chronic back arthritis, which can be painful and difficult to treat.

Kyphosis and

deformity

• If scoliosis goes untreated, the spine can continue progress from being curved to being fully twisted.

• This condition, known as ‘kyphosis’, can result in permanent deformity (with the patient always appearing hunched).

• It will definitely affect the patient’s condition as it is very painful

• In severe cases, scoliosis can cause the spine to twist to the point that it alters the location of the rib cage, causing it to be twisted around the body.

• This can lead to the ribs preventing the lungs from fully expanding, making breathing difficult.

• It can also lead to a rapid heart rate and frequent shortness of breath.

Breathing restriction

• Scoliosis can cause patients to have their hips at different levels

• Thus, it can cause alterations in the way they walk and stand.

• The primary change is that the patients with scoliosis have a more limited range of motion while they are walking, leading to them expending more energy and having a stiffer manner of walking than normal.

Gait changes

(manner of walking)

Treatment of scoliosis

Option 1: Do nothing

Option 2: Wear a brace

Option 3: Surgery

Option 1: Do nothing

• May be a reasonable decision depending on the age of the person and the predicted outcome.

• If the person is a teen or pre-teen and the prediction is that this curve will worsen then doing nothing may not be appropriate.

• This is because increasing curves usually give an increase in the deformity that is the chest twists throwing the shoulder blade off in back causing a rib hump.

Option 2: Wear a brace• Pros =) Bracing has been shown to be an effective method to prevent

curves from getting worse.• From a practical aspect, this treatment is reserved for children and

adolescents in whom the prediction of a rapid increase in the curve needs to be prevented.

• A brace worn 16 or more hours per day has been shown to be effective in preventing 90% or more of the curves from getting worse.

• Cons =( A back brace does not reverse the curve. Instead, it uses pressure to help straighten the spine. The brace can be adjusted with growth

• The brace is hot, hard, uncomfortable, ugly and while it normally can't be seen under the clothes definitely makes a teenager more self- conscious.

• It also seems to create problems of when to put it on, when to take it off, and for how long to wear it.

Option 3: Surgery

• Usually surgery is reserved for teen and pre-teens who already have a curve around 40 degrees or more.

• In the adult age range the reasons for doing surgery are less well defined but include an increasing discomfort or pain in a curve that appears to have increased.

• For many women the deformity in the hip line and the increasing discomfort combine to make surgery a reasonable option.

• Surgery however is a big deal and not to be undertaken lightly (high risk).

SURGERY….

THAT’S ALL….ANY QUESTIONS?