Post on 15-Aug-2015
ETIOLOGY
I. GENETICS• TWIN STUDIES• FIRST DEGREE RELATIVES- 11 %
AFFECTED• SEARCH FOR RESPONSIBLE GENES
II. TISSUE DEFICIENCIES• BONE - OSTEOPENIA• MUSCLE - CALCIUM METABOLISM• LIGAMENT/DISC
ETIOLOGY
III. VERTEBRAL GROWTH ABNORMALITIES• PROGRESSION RELATED TO
GROWTH• FASTER ANTERIOR GROWTH –
HYPOKYPOSISS -ROTATIONAL BUCKLING OF SPINE
• AIS PATIENTS TALLER THAN PIERS• INCREASED GROWTH HORMONE
(PETERNEWTON SANDIEGO)
ETIOLOGY
IV. CNS THEORIES
• MANY NEUROMUSCULAR CONDITION
• SYRINX ASSOCIATED WITH SCOLIOSIS
• MELATONIN DEFICIENCY• PINEALECTOMIZED CHICKENS
PREVALENCE
• >300 CURVE: 1-3/1000, M : F = 1 : 8• CURVE PROGRESSION IN
ADULTHOOD– RARE IF < 30O
– COMMON IF• >50-750 THORACIC• >30-400 LUMBAR 1 /YEAR
• BACK PAIN HIGHER RATE THAN CONTROLS
PATIENT EVALUATION
• ADAMS FORWARD BENDING TEST
• LOOK-FEEL-MOVE
WALKING, STANDING (BACK, SIDE,
FRONT), FORWARD BENDING,
FLEXIBILITY, NEUROLOGICAL
EXAMINATION
IMAGING
• STANDING PA / STAGNARA VIEW
• LATERAL: SAGITTAL DEFORMITY
• BENDS FILMS– SIDE BENDING, FULCRUM BENDING
• MRI : – AGE < 10, LEFT THORACIC,
NEUROLOGICAL FINDINGS
NON OPERATIVE TREATMENT
I. OBSERVATION < 20-250 IMMATURE
II. ORTHOSIS CURVE > 20-250 < 40-500 IMMATURE, RISSER < 3
BOSTON TYPE/MILWAUKEE
III. EXERCISE :
NO EVIDENCE TO SUPPORT THIS ALONE
BENEFICIAL IN BRACED PATIENTS
AIS : CURVE CLASSIFIKATION
LOCATION OF APEX
CERVICO-THORACAL : C7-T1/2 DISC
THORACIC : T2 – T11/12 DISC
THORACO-LUMBAR : T12-L1
LUMBAR : L1/2 DISC- L4
LUMBOSACRAL : L5-S1
LENKE, BETZ, HARMS JBJS 2001
CURVE PT MT TL.L CURVE TYPE
1 NS S NS MAIN THORACIC (MT)
2 S S NS DOUBLE THORACIC (DT)
3 NS S S DOUBLE MAJOR (DM)
4 S S S TRIPLE MAJOR (TM)
5 NS NS S TL/L
6 NS S S TL/L-MAIN THORACIC
CURVE TYPES (1-6)
LUMBAR CURVE MODIFIER :• POSITION OF CENTER SACRAL VERTICAL
LINE (CSVL) TO APEX OF LUMBAR CURVE
SAGITTAL THORACIC MODIFIER :• T5-T12 SAGITTAL COBB - : <100
N : 10 – 400
+ : > 400
CURVE CLASSIFICATION
CURVE TYPE (1-6)
+
LUMBAR CURVE MODIFIER (A,B OR C)
+
SAGITTAL THORACIC MODIFIER(-,N,+)
CURVE CLASS : 1A-,1AN, 6CN, 6C+
LENKE
• TYPE I : MT - PSSI OR ASSI
• TYPE II : DT- PSSI- PT + MT
• TYPE III : DMC – PSSI- MT+TL/L
MT ONLY < 600
MT RIGID
INFORMED CONSENT
SAFE L4 STOP AT L3
LENKE
• TYPE IV : TMC – PSSI – PT, MT,TL/L
• TYPE V : TL/L – ASSI TL/L ALONE
• TYPE VI : TL/L + MT
PSSI MT + TL/L
METHODS
THE 6,35 MM STAINLESS STEEL ROD IS PREBENDED IN KYPHOSIS IN THE THORACIC SPINE AND LORDOSIS IN THE LUMBAR SPINE
METHODS
DISTRACTION WITH THE SPREADER UNTIL THE HOOKS ARE LOCKED IN PLACE WITH THE ANTI ROTATION SYSTEM
METHODS
THE SUBLAMINAR WIRES ARE TIGHTENED ONE BY ONE GRADUALLY UNTIL THE CURVE CORRECTED BY PERIAPICAL TRANSLATION FOLLOWING THE LEEDS METHOD AND THE SCOLIOSIS IS CONVERTEDINTO NORMAL KYPHOSIS
METHODS
THE CORRECTED DEFORMITY IS NEUTRALIZED / STABILIZED USING THE SPINAL RECONSTRUCTION PLATE WITH SEGMENTAL PEDICLE SCREWS
METHODS
IN KING TYPE 1 CURVES AND LENKE TYPE 5 AND 6 THE ROD HAS TO BE CONTOURED AS AN “ S ” SHAPED BOTH IN THE SAGITTAL AND CORONAL PLANE WITH THE RECONSTRUCTION PLATE
AND FORMS A CROSSED INSTR.
METHODS
THIS INSTRUMENTATION IS NAMED THE UI SYSTEM AFTER UNIVERSITY OF INDONESIA WITH PATENT PENDING NO. P 00200200388
PATIENTS
FEB. 1998 – NOV. 2000
54 AIS MEAN AGE 17,5 YEARS
MEAN CURVE SEVERITY 72,2 DEGREES
MEAN CORRECTION 68,6%
RESULTS FOLLOW UP 2 YEARS
MEAN CORRECTION 68,6%
ALL COMPENSATED
NO HYPOKYPHOSIS
PATIENT’S / PARENT’S
SATISFACTION 85/100
CONCLUSIONS : THE UI SCOLIOSIS SYSTEM
* GOOD 3 DIMENSIONAL CORRECTION
* STABLE INSTRUMENTATION (NO EXTERNAL SUPPORT REQUIRED)
* INEXPENSIVE
OFFERS GOOD – EXCELLENT COSMESIS IN A BALANCED SPINE