عمليات العصب الاوسط بالمنظار- Current Endoscopic CTR techniques - البروفيسور فريح ابوحسان
Kyphosis البروفيسور فريح ابوحسان - تحدب العمود الفقري
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Transcript of Kyphosis البروفيسور فريح ابوحسان - تحدب العمود الفقري
Professor of OrthopaedicsProfessor of Orthopaedics
1/15/2011 ١Professor Freih Abu hassan -University of Jordan
Sagittal plane deformity in the thoracic orSagittal plane deformity in the thoracic or thoracolumbar spine
Thoracic Spine Kyphosis : 25 - 45 degrees
Typesyp1- Mobile2 Fixed2- Fixed3-Angular
1/15/2011 ٢Professor Freih Abu hassan -University of Jordan
1 Mobile Kyphosis1- Mobile KyphosisC t bl b th ti t’ l bCorrectable by the patient’s own muscles or by the surgeon
A PosturalA- PosturalB- Muscle weaknessB Muscle weaknessC- Compensatory to L. lordosis
1/15/2011 ٣Professor Freih Abu hassan -University of Jordan
Associated withAssociated with1-Flat feet2 f i i2-Women after child birth3- Obesity3 Obes ty
C.P
Painless, Correctable, , ,
Long curve, N. X-ray1/15/2011 ٤Professor Freih Abu hassan -
University of Jordan
T t tTreatment
Posture trainingPosture training
Exercises
Weight reductionWeight reduction1/15/2011 ٥Professor Freih Abu hassan -
University of Jordan
* Muscle dystrophy* Muscle dystrophy* Polio.(Lumbar lordosis and Thoracic kyphosis)Thoracic kyphosis)
1/15/2011 ٦Professor Freih Abu hassan -University of Jordan
* Gross hip deformity e.g hip dislocation ,fi d fl i hi d ffixed flextion hip def.
lumbar lordosis Thoracic kyphosisyp
1/15/2011 ٧Professor Freih Abu hassan -University of Jordan
Compensatory to L. lordosis1/15/2011 ٨Professor Freih Abu hassan -
University of Jordan
2- Fixed Kyphosis2- Fixed KyphosisNot correctable by the patient’s own muscles orNot correctable by the patient s own muscles or by the surgeon
Types1 S h ’ di1- Scheuermann’s disease2- A. Spondylitisp y3- Senile kyphosis4 Bone dysplasia4- Bone dysplasia5- with Scoliosis
1/15/2011 ٩Professor Freih Abu hassan -University of Jordan
Scheuermann’s dis
Senile kyphosis
1/15/2011 ١٠Professor Freih Abu hassan -University of Jordan
3-Angular Kyphosis3-Angular Kyphosis1- Cong.1 Cong.2- T.B3 V b l b d ll3- Vertebral body collapse= Trauma, Tumour,= infection
C l ’= Calve’s5- Deficient post bony elementsp y= post laminectomy, Spina bifida
1/15/2011 ١١Professor Freih Abu hassan -University of Jordan
1/15/2011 ١٢Professor Freih Abu hassan -University of Jordan
T BT.B
1/15/2011 ١٣Professor Freih Abu hassan -University of Jordan
Progressivek hkyphus
T.B
Lumbar abscess ١٤
Coin test1/15/2011 Professor Freih Abu hassan -
University of Jordan
Calve’sCalve s
1/15/2011 ١٥Professor Freih Abu hassan -University of Jordan
Kyphoscoliosis
1/15/2011 ١٦Professor Freih Abu hassan -University of Jordan
Age related KyphosisAge related Kyphosis1- Child Cong1 Child Cong.,2- Adolescent Postural,,
Scheuermann’s disease3- Young adult A.S4 Elderly Senile Path #4- Elderly Senile, Path. #,
Paget’s.Paget s.5- All age group T.B
1/15/2011 ١٧Professor Freih Abu hassan -University of Jordan
KYPHUS
1/15/2011 ١٨Professor Freih Abu hassan -University of Jordan
Scheuermann’s diseaseScheuermann s diseaseCauses
1- Unknown
Causes1 Unknown2-Osteochondritis (irregular ossification of epiphyseal plates)(irregular ossification of epiphyseal plates)
3- Undue strain on the ant. ti f th t b l b diportion of the vertebral bodies
4-Traumatic infarction of the epi. plates5-Vertebral osteoporosis and the discsherniate in the fragile bonee e e g e bo e1/15/2011 ١٩Professor Freih Abu hassan -
University of Jordan
= Starts at puberty= Starts at puberty= > in females > in females= Round shoulders= Back pain + fatigue
1/15/2011 ٢٠Professor Freih Abu hassan -University of Jordan
1/15/2011 ٢١Professor Freih Abu hassan -University of Jordan
O/EP= Poor posture
= Smooth kyphosis= Smooth kyphosis= Lumbar lordosis= Non correctable= Full ROM
Ti ht h t i !!!????= Tight hamstrings!!!????
1/15/2011 ٢٢Professor Freih Abu hassan -University of Jordan
X ra sX-rays* Wedging ant > 5 degree of eachWedging ant. > 5 degree of each
vertebra D6 - D10* Contain small translucent areas
(Schmorl’s nodes)(Schmorl’s nodes)* Fragmented ant. epiphyseal platesg p p y p
> 3 Vertebrae* A 40* Angle > 40
1/15/2011 ٢٣Professor Freih Abu hassan -University of Jordan
1/15/2011 ٢٤Professor Freih Abu hassan -University of Jordan
D DxD.Dx1- Postural: Painless, Correctable, , ,
Long curve, N. X-ray2 T B2-T.B= Angular kyphos Angular kyphos= X-ray : = destruction at least two
adjacent vertebrae with= narrowing of the disc += narrowing of the disc + = paravertebral abscessp ve eb bscess
1/15/2011 ٢٥Professor Freih Abu hassan -University of Jordan
R/R/= 40 60 Degree= 40-60 Degree Postural trainings gStrengthening exercises.
= 60 degree in young child 60 degree in young child Corrective cast for 6 m followed by Milwaukee brace until remodelling of the vertebrae.vertebrae.
1/15/2011 ٢٦Professor Freih Abu hassan -University of Jordan
R/R/Older adolescent and adult 60= Older adolescent and adult 60 degreedegree
* If painful , > 60 degree, or impending paresis.1 ant release and m ltiple disc e cision1- ant. release and multiple disc excision2- traction for 2 weeks3- Post fusion
1/15/2011 ٢٧Professor Freih Abu hassan -University of Jordan
1- Cosmesis2- Stop progression3- Alleviate pain4- Prevent pain in the future
1/15/2011 ٢٨Professor Freih Abu hassan -University of Jordan
Scheuermann’s disease
1/15/2011 ٢٩Professor Freih Abu hassan -University of Jordan
Types1 F il f f i f b l1- Failure of formation of vertebral
body 20% paralysisbody. 20% paralysis2-Failure of segmentation
Very slow progression, no risk of paralysisparalysis
3-Combination1/15/2011 ٣٠Professor Freih Abu hassan -
University of Jordan
1/15/2011 ٣١Professor Freih Abu hassan -University of Jordan
1/15/2011 ٣٢Professor Freih Abu hassan -University of Jordan
1/15/2011 ٣٣Professor Freih Abu hassan -University of Jordan
1/15/2011 ٣٤Professor Freih Abu hassan -University of Jordan
1/15/2011 ٣٥Professor Freih Abu hassan -University of Jordan
Type 1P t f i ith t i t t tiPost fusion without instrumentation at the age of 3 years.at the age of 3 years.If seen late ant. strut graft and after 2-4 weeks post fusion
Type 3 Ant.& Post fusion1/15/2011 ٣٦Professor Freih Abu hassan -
University of Jordan
1- Senile2- Senile osteoporosis3- Paget’s4- Pathological #
1/15/2011 ٣٧Professor Freih Abu hassan -University of Jordan
S il k h iSenile kyphosis= More in males= More in males.= Multiple discs degeneration causing
narrowing followed by slight wedging= little pain unless development of little pain unless development of
Facet O.A.
1/15/2011 ٣٨Professor Freih Abu hassan -University of Jordan
Senile OsteoporosisU ll i hi f l= Usually in thin females.
= Wide spread osteoporosis Wide spread osteoporosis= Code fish spine= Pain is common due to fracturesOr due to compensatory lumbarOr due to compensatory lumbar
lordosis or O.A
1/15/2011 ٣٩Professor Freih Abu hassan -University of Jordan
R/= ANTI OSTEOPOROSIS R/
STICK= STICK= ANALGESIA= ANALGESIA
1/15/2011 ٤٠Professor Freih Abu hassan -University of Jordan
1/15/2011 ٤١Professor Freih Abu hassan -University of Jordan
Paget’s kyphosis= due to bone softening= associated criteria of paget’s= associated criteria of paget s
(thick bent bones)(thick bent bones)= large vertebra with coarse
trabeculation
1/15/2011 ٤٢Professor Freih Abu hassan -University of Jordan
Pathological # kyphosisT= Trauma
= Metastasis Metastasis
R/*With neurology Surgery*With neurology - Surgery*No neurology Radio/ +Brace.gy
1/15/2011 ٤٣Professor Freih Abu hassan -University of Jordan
= Cong.g= Neuromuscular= Post surgeryg y
1/15/2011 ٤٤Professor Freih Abu hassan -University of Jordan
1/15/2011 ٤٥Professor Freih Abu hassan -University of Jordan