10. The intersection of a line parallel to the
superior end plate of the most cephalad
vertebra in a particular curve, with the line
parallel to the inferior end plate of the most
caudad vertebra of the curve.
The most cephalad end vertebra is the
vertebra that has the greatest tilt from the
horizontal of its superior end plate (solid line).
The most caudal end vertebra is the vertebra
that has the greatest tilt from the horizontal of
its inferior end plate
The apical vertebra (A) is the most laterally
deviated vertebra from midline. Drawing lines
along several vertebrae near each end of a
curve (dashed lines) is helpful in determining
that with the greatest tilt.
Measuring the Cobb angle
11. a visual grading of the degree to which the
iliac apophysis has undergone ossification and
fusion and is used to assess skeletal maturity
on PA spinal radiographs.
The iliac apophysis ossifies in a stepwise
fashion from anterolateral to posteromedial
along the iliac crest.
The Risser grades are as follows:
- 0 – No ossification
- 1 – Up to 25% ossification
- 2 – 26 to 50% ossification
- 3 – 51 to 75% ossification
- 4 – Greater than 76% ossification
Risser sign
12. Clasificarea Stagnara
0-30 grade – ușoară
30-56 grade - mediu
Peste 50 grade - grav
Peste 90 grade – foart grav
13.
14. Prognostic, Screening
Progresie – jumate ani:
• 2-3 grade – formă ușoară
• 5 grade – progresie semnificativă
De exemplu o deviere de 20 de grade:
• Copil de 5 ani – alarmant
• Copil de 10 ani – de ingrijorat
• Copil de 16 ani – fără stres
Program de screening național, copii intre
8 si 14 ani.
17. Tratament cu corset
Idea de bază constă în
deplasare tridimensională
Corsetul ideal – tracțiune
- presiune
- derotare
Corecția trebuie să fie 3D
Efect pe coloană
21. Tratament chirurgical
Tratamentul chirurgical are următoarele
indicaţii:
• deviaţii peste 30 grade lombar
• deviaţii peste 40 grade la alte localizări
• gradul între 4-5 după clasificarea Risser
• progresie anuală mai mare de 10 grade
Operaţia Harrington.
Spondilodeză.
Corecţia tridimensională după Cotrel-
Dubousset