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Idiopathic Scoliosis

Presentation into Idiopathic Scoliosis, physiotherapy post-op management (posterior instrumented fusion).
by

Jonathan Nicholas

on 12 September 2013

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Transcript of Idiopathic Scoliosis

Idiopathic
Scoliosis
Jonathan Nicholas
Band 5
Physiotherapist
What is Scoliosis?
Types
Aetiology/Cause
'an abnormal sideways
curvature of the spine'
C Curve
S Curve
Cobb Angle > 10 degrees
Introduction
Congenital
Early Onset
Late Onset
Neuromuscular
Syndromic
Degenerative
70 - 80% - idiopathic
Most patient do not require treatment
Many theories
6 in 10,000
(late onset)
require treatment
1:1 (M:F)
curves up to
10 degrees
1:5 (M:F)
curves > 10 degrees
More common in tall
& slim females
Gummerson & Milner (2011)
Gummerson & Milner (2011)
Gummerson & Milner (2011)
Symptoms
other joint problems
back pain
leg length discrepancy
abnormal gait
uneven
shoulder/pelvis
Diagnosis
Pathway
Observation
GP
Scoliosis Specialist
Tests
Adam's forward
bend test
x-rays
MRI
Classification
2 Dimensional
1st:
Curve Apex
T2 - 12 Thoracic
T12 - L1 Thoracolumbar
L1 - L4 Lumbar Curve
2nd:
kyphosis
a degree of kyphosis
Cobb
Angle
Risser Scale
0 - 1 rapid growth
4 - 5 stopped growing
Case Study
Treatment
Post-op Management
& Physiotherapy
References
Conservative
Management
Surgical
Treatment
Physiotherapy
Bracing
Research
Haefeli et al. 2006
Cobb angle > 45 degrees
Objectives
1. Stop Progression
2. Achieve maximum permanent correction
3. Improve Appearance
4. Reduce long/short term complications
youth = flexibility
Posterior
Instrumented
Fusion
Seen by specialist Autumn 2011
Cobb was 42 degrees
Symptoms: occasional back pain & right shoulder slightly protruding
No History
Objective Ax & x-rays
S curve - T5 - 11 (T8/9) & T11 - L4 (L1/2)
Risser status of 4
Patient initially went without surgery but 3 - 4 months later the scoliosis had progressed and surgery was given the go ahead.
Summary
approx. 7 - 10 day hospital stay
post-op physiotherpy from day 1
Approx. a year to fully recover
Patient tend to be in their teens
Pain Relief
Physiotherapy
Early Mobilisation
Advice/Education
Exercises
Chest Physiotherapy
High pain levels
To help mobilise
Comfortable
Case Study Review
Questions?
Gummerson NW & Millner PA (2011) Scoliosis in Children and Teenagers. Orthopadics and Trauma. 25 (6) 403 – 412.Haefeli M, Elfering A, Kilian R, Min K & Boos N (2006 Non-operative treatment for adolescent idiopathic scoliosis: a 10 to 60 year follow-up with special reference to health related quality of life. Spine. 31 (3) pp 355 – 366.Raso VJ (unknown) Review of Biomechanics in the etiology of idiopathic Scoliosis. British Scoliosis Research Foundation. (accessed at http://www.bsrf.co.uk/uploads/Abstract%2068.pdf on 3.8.12)Scoliosis Association (UK) (2012) Scoliosis Association (UK). (accessed at http://www.sauk.org.uk/ on 03.08.2012).Scoliosis Research Society (2012) Scoliosis Research Society. (accessed at www.srs.org on 11.08.2012)Weinstein SL, Dolan LA, Cheng JCY, Danielsson A & Morcuende JA (2008) Adolescent Idiopathic Scoliosis . The Lancet. 371; 1527 – 1537.
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