Chapter 26- Spinal deformity

Question 1

Primary causes of scoliosis

Answer 1

1. idiopathic
2. Paralytic: poliomyelitis
3. Congenital (vertebral anomaly)
4. Neurofibromatosis

Question 2

Secondary causes of scoliosis

Answer 2

1. Postural: adolescents
2. Compensatory: Short leg or pelvic tilt due to hip contracture
3. Sciatic: Lateral tilt with pain due to disc herniation

Question 3

effect of scoliosis on the patient

Answer 3

• cosmetic/ psychological
• respiratory impairment
• pain
• neurological deficit

Question 4

Screening test for scoliosis

Answer 4

Adam’s test

Question 5

Treatment of idiopathic scoliosis in growing child

Answer 5

<25 degrees: Xray 4 monthly and if progression, consider corrective brace until maturity

25- 50 degrees: offer brace or surgical correction

> 50 degrees: Corrective spinal fusion

Question 6

Treatment of idiopathic scoliosis after completion of growth

Answer 6

Surgery: instrumentation and fusion if poor cosmesis, respiratory impairment or pain

Question 7

causes of kyphosis

Answer 7

• congenital: vertebral anomalies
• traumatic: wedge compression fracture
• infective: TB spondylitis
• inflammatory: ankylosing spondylitis
• Neoplastic: pathological fracture from tumor infiltration
• metabolic: osteoporosis
• miscellaneous: scheurmanns disease, neurofibromatosis, neuromuscular paralytic conditions

Question 8

effects of kyphosis

Answer 8

• Respiratory impairment
• Cosmesis
• pain
• paraplegia

Question 9

treatment of congenital kyphosis

Answer 9

early spine fusion

Question 10

treatment of active TB spondylitis

Answer 10

• Anti-TB drugs for 9- 12 months

- Evacuation of the spinal abcess and reconstruction

Question 11

Treatment of healed TB spondylitis

Answer 11

Surgical decompression and reconstruction

Question 12

treatment of neoplastic causes of kyphosis

Answer 12

-confirm diagnosis with needle or open biopsy
Benign: excision, possibly spine fusion
Malignant: surgery and/or irradiation

Question 13

Treatment of metabolic cause of kyphosis (osteoporosis)

Answer 13

rest, analgesia
DEXA scan
Calcium, vitamin D, bisphosphanates