1. ORTHOTIC MANAGEMENT OF
SCOLIOSIS
Prepared by:
MUHAMMAD IBRAHIM KHAN
BS.PT(Pak), MS.PT(Pak), NCC(AKUH)
2.
3. Scoliosis
– 3-dimensional deformity of the
spine affecting all the 3 planes.
– Can be difficult to visualize with
2-dimensional radiographs
– Scoliosis is a lateral deviation of
the normal vertical line of the
spine which, when measured by
an X-ray, is greater than 10
degrees accompanied by vertebral
rotation.
4. Scoliosis
“Normal” alignment
• Spinous processes all line up in
a straight line over the sacrum
Scoliosis is a combination of
• Angular displacement
• Lateral displacement
10. CONGENITAL SCOLIOSIS
The critical time is the time of segmentation
process (First Six weeks) and congenital
anomalies develop during this period of time.
In the presence of vertebral anomalies, there
is an imbalanced growth of spine resulting in
congenital scoliosis.
11. Classification
By MacEwen et al. later modified by Winter, Moe, and Eilers
• FAILURE OF FORMATION
Partial failure of formation (wedge vertebra)
Complete failure of formation (hemi vertebra)
• FAILURE OF SEGMENTATION
Unilateral failure of segmentation (unilateral un segmented
bar)
Bilateral failure of segmentation (block vertebra)
13. Patient Evaluation
Examine the skin of back for hair patches,
dimples, and scars.
Look for the evidence of neurological
involvement, such as clubfoot, calf
atrophy, absent reflexes and atrophy of one
lower extremity compared with the other.
Look for the other congenital anomalies.
14. Screening hints
• Shoulders are different heights
• Head is not centered directly
above the pelvis
• Appearance of a
raised, prominent hip
• Rib cages are at different
heights
• Uneven waist
• Changes in look or texture of
skin overlying the spine
(dimples, hairy patches, color
changes)
• Leaning of entire body to one
side
15. Scoliometer
An inclinometer (Scoliometer) measures
distortions of the torso.
•The patient bends over, arms dangling
and palms pressed together, until a curve
can be observed in the upper back
(thoracic area).
•The Scoliometer is placed on the back
and measures the apex (the highest
point) of the upper back curve.
•The patient continues bending until the
curve can be seen in the lower back
(lumbar area). The apex of this curve is
also measured.
16. 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.
17. Measure spinal curvature using
Cobb method
- Choose the most tilted
vertebrae above & below
apex of the curve.
- Angle b/w intersecting lines
drawn perpendicular to the
top of the superior vertebrae
and bottom of the inferior
vertebrae is the Cobb angle.
18.
19. Diagnosis
• Physician Physical Exam
• Scoliometer measurements
• X Ray
• MRI
21. Observation
Non progressive curves and Minor curves (>20
degrees) and with other congenital anomalies.
Skeleton is close to maturity
Exercises may help with surrounding muscular
strength.
Limited value in patients with congenital
scoliosis.
23. Bracing
• Usually works on the vertebrae outside the
actual congenital deformity.
• Compensatory curves also can be successfully
managed for several years with orthotic
treatment.
• Lumbar curves can be treated in a TLSO, but
thoracic curves require a Milwaukee brace.
29. Bracing
Milwaukee brace
Three types of curves respond to brace
management:
1- Long, flexible curves,
2- Curves that could be corrected either in
traction or on side bending,
3- Curves with a mixture of anomalous and
non-anomalous vertebrae.
30. Successful Bracing
• Prevent curve progression
– Randomized study
• Braced 74% did not progress
• Not braced 34% did not progress
• Charleston brace still controversial
31. Problems with Braces
• Argued efficacy
• Narrow treatment window to initiate
• Poor compliance
• Must have good orthotist
– Curves corrected by 20 degrees in brace do better
