SPINAL DEFORMITIE’S

BY ,
NEHA GAGGAR (MPT)
 SPINAL DEFORMITY
DEFINTION :
any abnormality of the formation , alignment , or shape of the vertebral column .
TYPES :
1. Frontal plane
scoliosis
2. Sagital plane
 forward head
 kyphosis
 exaggerated lordosis
 flat back
However SCOLIOSIS have multiplanar component :
 frontal
 sagital
 torsional
 SCOLIOSIS

DEFINITION :
Appreciable lateral deviation (>10 degrees) in the normally straight vertical line of
spine.

ETIOLOGY :
 Genetic
 Disorders of bone , muscle, disc
 Developmental growth abnormalities
 Central nervous system causes
 CLASSIFICATION

SCOLIOSIS

STRUCTURAL NONSTRUCTURAL

A.Idiopathic A.Postural
 Infantile(0-3yrs) B.Compensatory
 juvenile (4-9yrs) C.Sciatic
 Adolescent (10-20 yrs)
B.Congenital
C.Neuromuscular
 GRADES OF SCOLIOSIS

Grade I mild postural scoliosis

Grade II structural scoliosis with curve < 40 degrees

Grade III structural scoliosis with curve > 40 degrees

 CURVE PATTERNS
1.Cervical curve : apex between C1 – C6
2.Cervicothoracic curve : apex is at C7, T1
3.Single major thoracic curve : Apex is between T2 – T11
4.Single major high thoracic curve : Apex from T3 with the curve
extending from C7 or T1 to T4 or T5
5.Single major lumbar curve: Apex between L1-L2 and L4
6.Single major thoracolumbar curve : Apex is at T12 or L1
7.Combined thoracic & lumbar curves (double major curves) :
Symmetrical double major curves
8.Double major thoracic curve :
Upper thoracic from T1 to T5 or T6 and convex to the left
SCOLIOTIC CURVES

1. Compensatory curve due to primary curve

2. Compensatory curve due to deformities in other
parts of the body
3. Rotational element
 EVALUATION

I. INSPECTION
A.OBSERVATION
1.level of ear & contour of neck
2. shoulder level
3. scapular level
4. position of the arms and the waist line
5. back
6. thorax
concave : ribs crowded & flattened
convex : ribs apart & buldge backwards
7. hips & PSIS
8. pelvis : concave : forward rotation
9.knee
10.feet
EVALUATION CNTD...

B. ADAMS TEST

II. EXAMINATION
1. Range of motion
2.scoliometer
 EVALUATION CNTD...
3.Cobb angle
measurement :
The Cobb method is used to measure the degree of scoliosis
on the posteroanterior radiograph .

STEP 1 : the apical vertebra is first identified; this is

the most likely displaced and rotated vertebra with
the least tilted end plate.

STEP 2 : The end/transitional vertebra are then

identified through the curve above and below.
The end vertebra are the most superior and inferior
vertebra which are least displaced and rotated and
have the maximally tilted end plate. 

STEP 3 : A line is drawn along the superior end plate

of the superior end vertebra and a second line drawn
along the inferior end plate of the inferior end vertebra.
The angle between these two lines (or lines drawn
perpendicular to them) is measured as the Cobb angle.
 EVALUATION CNTD...
4. To check vertebral rotation :
 Nash and moe method,
 Look at the pedicles
 If they are equidistant from the sides of the vertebral bodies ,
no vertebral rotation (0 rotation)
 Grade 4 is in which the pedicle is past the center of the
vertebral body.

5. Skin marker
EVALUATION CNTD...

6.Rib Mehta’s angle

(Difference at the apical rib) is of prognostic value.
The RVA difference (RVAD) is the difference between the values of the RVAs on the
concave and convex sides of the curve [apical vertebra].
If the convex apical rib head does not overlap the apical vertebral body, a curve with an
initial RVAD of 20º or more is considered progressive.
One line perpendicular to the apical vertebral endplate and another from the mid neck to
the mid head of the corresponding rib.

7.MRI
8.CT Myelography
 MANAGEMENT

OBSERVATION BRACING

SURGERY
 PREVENTIVE ROLE

 early detection

 screening programme for all school children of age

between 10-14 yrs

 education of parents and teaching them simple

observational technique
BASIC PRINCIPLES OF CORRECTION

1. ACTIVE CORRECTION :
self corrective postural activities

2. PASSIVE CORRECTION :
Unequal hanging
Axial traction given by 2 therapists

3. MAINTENANCE OF CORRECTION :
Education of patient
Spinal bracing
 MANAGEMENT FOR GRADE I

 Re-education of bad posture

 monitoring after every 6 months
 regimen includes:
 general body relaxation
 re-education of correct posture
 passive correction
 repeated session of maintenance of corrected posture
 general free mobility exercises
 strengthening – spinal extensors, abdominals
 deep breathing ex
 balance ex
 stretching of concave side
 avoiding activities prone to produce the deformity
 MANAGEMENT FOR GRADE II

MILWAUKEE BRACE
Aka Cervicothoraciclumbosacral orthotic (CTLSO brace)

•Adjustable ht, can ‘grow’ with the patient

•Worn 23 hrs/day
•Contains pelvic attachment, thoracic pads,
and chin support
•Primary goal = stop progression of
scoliosis
•Very effective if treatment plan is followed
BOSTON BRACE
Aka ‘Low Profile’ Thoracolumbarsacral orthotic (TLSO)

•Primarily used for lower thoracic,

thoracolumbar , & lumbar curves

•Still widely used, due to better

patient acceptance than Milwaukee
Brace
EXERCISE THERAPY
 Goals = Improve ROM
• Especially in direction of convexity
• Reduce contractural change of soft tissues on
concave side
 Done through:
• Improve strength, endurance, & postural control of
muscles on convex side
• Identify & correct vestibular and/or
proprioceptive imbalance/deficiency
• Improve balance & coordination
• Normalize weight bearing in lower extremities &
spine
Specific Exercises:
• Stretch concave side = balance ball, hanging from bar,
leaning against wall

• Strengthen convex side = active exercise

• Strengthen trunk muscles

• Rotary torso exercises to left (right thoracic curve)

• Proprioceptive training

• Heel lift (up to 5 mm) – goal is to balance weight bearing

for CNS re-education, re-evaluate every 6 weeks
•Exercises to restore cervical lordosis
•Work with Exercise Ball – proprioceptive control
•Sleep posture – lying on side with pillow under ribs

•To correct pelvic unleveling (ex. elevated Rt. Ilium)

• Strengthen: Lt. QL, Lt. hip adductors, Rt. G Med
• Stretch: Rt. QL, Rt. hip adductors, Lt. G Med
•Breathing exercises – maximize & normalize chest
expansion
 MANAGEMENT FOR GRADE III
Surgery is the treatment of choice
TRACTION

NONSKELETAL SKELETAL

1.Combination of
intermittent and
continuous
1.Halopelvic
2. Superimposition of
2. halofemoral
both
3. Traction of
gravitational
 INDICATIONS FOR SURGERY

1. Cord compression
2. Rapid progressive curve
3. Severe pain
4. Respiratory impairment
5. Cosmetic
 AIMS OF SURGERY

1. Restore the symmetry of trunk as much as possible

2. Straighten the thoracic curve to stop decrease in pulmonary
function
 PRINCIPLES OF SURGERY

I . CORRECTION OF CURVE :
1. turnbuckle cast techniques
2. distraction technique
3. lessening of the curve
II. MAINTENANCE OF CORRECTION ACHIEVED
1. spinal fusion
2. spinal instrumentation
 harringtons instrumentation
 segmental spinal instrumentation
 Dwyers instrumentation
 Zieko instrumentation
 PREOPERATIVE PHYSIOTHERAPY

 measurements
 assessment of pulmonary function
 muscle charting
 detailed neurological examination
 gait analysis and functional status
 postural guidance
 spinal stretching and mobility
 POSTOPERATIVE PHYSIOTHERAPY
FIRST 2 DAYS
 Respiratory status
 Ankle toe movements
 upper extremity mobility
Passive movts to lower limb
 turning every 2 hrly
3 RD & 4 TH DAY
 Active movts for lower limb
 measurement of curve
AFTER 5 DAYS
 Guidance in rolling , sitting , standing
 sitting
 chair sitting
 standing and walking
THANK YOU....