Idiopathic Deformities of the Spine - Beta.pdf

Idiopathic Deformities of the Spine Musculo-Skeletal Physiotherapy II Sonia Liébana Sánchez-Toscano, PhD Scoliosis What does scoliosis mean? 2 Scoliosis 3 Scoliosis 4 Scoliosis • Lateral deviation Vs Tridimensional deformity • Idiopathic • Types: – Idiopathic 80%: infant (0-3 y), juveni...

Idiopathic Deformities of the Spine Musculo-Skeletal Physiotherapy II Sonia Liébana Sánchez-Toscano, PhD Scoliosis What does scoliosis mean? 2 Scoliosis 3 Scoliosis 4 Scoliosis • Lateral deviation Vs Tridimensional deformity • Idiopathic • Types: – Idiopathic 80%: infant (0-3 y), juvenile (3-10y), adolescent (10-21y) and adult (+21y) – Congenital 10% – Neuromuscular 5-7% – Mesenchymal disorders 2-3% 5 Scoliosis • Morphological or structural: bone deformation. • No morphological or postural or functional (scoliotic attitude): without bone deformity. 6 Idiopathic Scoliosis • “Three-dimensional deformity of the spine with unknown cause, characterized by lateral deviation, axial rotation and sagittal spine configuration changes.” Rib cage gets also affected… • 3D • scoliosis = side bending + axial rot + kyphotic rectification 7 Components of the scoliotic injury • 1. Lateral Curve: defined by an upper limit vertebra, a lower limit vertebra and and apex segment – Apex segment/curve apex: Farthest from midline (occipitosacral axis) point of the curve. If it´s made up of a vertebra, it´ll be the most rotated and deformed (wedge shape deformity). – Upper limit vertebra: Its superior endplate has the maximum inclination towards the concavity of the curve. – Lower limit vertebra: Its inferior endplate has the maximum inclination towards the concavity of the curve. 8 Components of the scoliotic injury • 1. Lateral Curve According to SRS: – Direction: Stated by the curve convexity side (right/left) – Location: Stated by the apex segment position: Cervical: C1-C6  Cervicothoracic: C7-T1  Thoracic: T2-T11  Thoracolumbar: T12-L1  Lumbar: L2-L4  Lumbosacral: L5-S1  9 Components of the scoliotic injury • Lateral curve measurement – COBB ANGLE () – Deviation of the spine in the frontal plane – 1st identify limit vertebrae (sup & inf) – Draw endplates tangents [and their perpendiculars (opc.)] –  results from tangents or tang.perp. Intersection – Idiopathic Scoliosis if  = ó > 10º (according to SRS) Interobserver variation ± 5º 10 Components of the scoliotic injury 11 Components of the scoliotic injury • 2. Axial Rotation – Vertebral rotation in the apical segment is measured – TYPICAL S: Rotation against lateral deviation (contralat) – ATYPICAL S: Rotation towards lat deviation (ipsilat) 12 Components of the scoliotic injury • Axial Rotation measurement: – Frontal (PA) X-Ray – Apical segment (greater rotation) – Convexity vertebral pedicles 13 Components of the scoliotic injury • Perdriolle Method to measure axial rotation: – Frontal (PA) X-Ray – Perdriolle torsion meter – Apex vertebra – Confine lateral bone corticals – Measure through the pedicle alongside convexity 14 Components of the scoliotic injury 3. Changes in vertebral sagittal setting: – Coupling Principle Every spine segment must remain extended (correction, lordosis) so that ipsilateral rotation can occur – Kyphoscoliosis??? 15 Components of the scoliotic injury 16 Components of the scoliotic injury 17 Mechanical Torsion • Is the three-dimensional movement of an element submitted to a F moment consisting of 3 vectors • Every spine segment is plastic and it´s located on an axial/longitudinal axis • Each of the three space planes and axes must be taken into account as a set • Affects both soft and bony tissue: • Intervertebral Torsion • Intravertebral Torsion 18 Mechanical Torsion • Intervertebral Torsion – Causes different orientation in space between two different vertebrae because an INTERVERTEBRAL DISC torsion occurs – Minimal or non-existent in the apical segment and maximum near the neutral vertebrae (outwardly limit vertebrae, non rotated neither wedged) 19 Mechanical Torsion • Intravertebral Torsion – Causes a different spatial orientation between the two endplates of a single vertebra – Maximum in the apical vertebrae and null in the neutral vertebra (first non rotated neither wedged vertebra, adjacent to the curve) – Responsible deformity for osseous 20 Geometric Torsion • Three-dimensional movement of the axial cyllinder (made up of vertebral bodies ensemble) • Each spine point changes its position according to a global ccordinates system to integrate altogether a virtual line that joins every vertebral body • Again, three spatial planes and axes must be consideres as a set 21 Geometric Torsion 22 Muscular Imbalance • Initially, as an adjustment to bony deformity, a muscular primary functional asymmetry begins which, subsequently, will affect muscular length and produce histopathological changes that will impact on muscular activity during erect position, being established within the scoliotic injury a seccondary muscular intrinsic imbalance. 23 Muscular Imbalance • Longitudinal Concavity Musculature – Shortened, relatively inelastic – Little or null EMG activity –  type I muscle fibers – Normal amount of type II muscle fibers 24 Muscular Imbalance • Longitudinal Convexity Musculature – Elongated, relatively inelastic – Greater EMG activity –  type I fibers – Atrophy of type II fibers 25 Muscular Imbalance • Summarizing… – There is an overload/overexertion in the longitudinal convexity musculature – OJO → Both sides are weakened, but muscles in concavity side have mechanical advantage over those in convexity 26 Muscular Imbalance • Imbalance is not just dorsal... – Oblique abdominal musculature – Typical scoliosis (r): diagonal R external Oblique – L internal Oblique is stretched – During front bending both diagonals will contract, but the shortest diagonal will increase rib cage and spinal rotation, so the hump will be increased 27 Trunk Deformity • True expression of the three-dimensional disorder • Accurate tool for a PT who knows what (and how) to observe... • Digital Photographic Control: – 2 frontal plane photos (face/rear) + 2 laterals (right/left) – Cheneau adds 2 oblique dorsal at 30º and 60º on each side – Salvá Institute: 2 frontal (face/rear) and 2 obliques at 45º (on each side) 28