Beruflich Dokumente
Kultur Dokumente
SCOLIOSIS
Rochmanita Safitri
11/ KU/14786
Nama : Nn. VN
Usia : 34th
Jenis kel : Perempuan
Alamat : Wates
Tgl. Periksa : 13 June 2017
No. RM : 01.XX.XX.XX
Pemeriksaan : Thorax AP
Keluhan Utama :
Sesak dan nyeri punggung.
Hasil Foto Thorax
Tampak foto thorax dengan
proyeksi AP, posisi erek, kualitas
cukup.
Tampak opasitas homogen dg
batas tidak tegas pada kedua
pulmo yang mengaburkan
pembuluh darah, air bronkogram
(+)
Tampak zona lusen pada apex
pulmo dekstra.
Tak tampak pelebaran pleural
space.
Tampak diafragma dekstra licin
dan tak mendatar, diafragma
sinistra tak dapat dinilai
CRT : tidak dapat dinilai
Tampak VT melekuk ke kanan
Kesan :
suspect pneumothorax dextra,
besar cor tak dapat dinilai, dan
Hyperdextroscoliosis Thoracalis
SCOLIOSIS
Scoliosis
Abnormal lateral curvature of spine
in which there is deformity in the
coronal plane. Cobbs Angle >10
degree.
May alter sagittal plane as well
Thoracic kyphosis normally = 30-35
degrees
Range 10-50 degrees
Lumbar lordosis normally = 50-60
degrees
Range 35-80 degrees
Spinal rotation causes posterior
prominence
Upto 10 degrees is
normal.
Can be seen as C-
curve or S-curve.
S- curve is usually
compensatory.
Demographics :
Occurs in 2-3% of population below the age of
16 years.
0.1% have a curve greater than 40 degrees.
Girls are more affected than boys.
Those with a curve of more than 30 degrees are
generally girls, outnumbering boys by 10:1.
Generally progresses during the period of
growth spurts.
Adolescents are more routinely tested for this.
Types of Scoliosis
Congenital
Neuromuscular
Cerebral palsy
Syndrome related
Marfans syndrome
Idiopathic
http://www.pediatriceducation.org/2006/12/11/
Physical Examination:
Features suggestive of polio, neurofibromatosis,
Von Reclinghausen syndrome, Downs,
Marfans, Hurlers syndrome, neural tube defects
and osteogenesis imperfecta.
Forward protrusion of chest wall on affected
side.
Increased flank creases on opposite side.
Higher ASIS and PSIS on concave side.
Spinous process turned into concave side.
Tests of flexibility of spine:
Adams forward bending test.
Lateral bending.
Forward Bend Test
Adams sign
Early Detection:
Visual examination of
gait, posture, limb length
and lateral curvature of
spine.
A posterior view taken,
bent at 90 degrees at
hips.
Can also be detected
accidently when
radiographs are taken to
rule out other
pathologies.
Once scoliosis is suspected:
A scoliosis series is
ordered.
AP cervical, thoracic
and lumbar spine
Xrays collimated to
soft tissues needed.
Sometimes lateral
views may also be
necessary.
Imaging
Plain x-rays
Need standing 36 inch cassette
Posterior to anterior
Decrease thyroid and breast exposure 3-7 fold
Note rotation
Measure deformity by Cobb method
Skeletal maturity
Normal spine radiology
Cobb Method
Choose the most
tilted vertebrae above
and below the apex of
the curve.
Draw a line
perpendicular to that
vertebrae.
The angle created
between these
intersecting lines is
the Cobb angle.
Rotation
Spinous process rotates into concavity
Pedicle position
Risser sign due
to sceletal
maturity
daytime/nighttime braces.
Stretches, exercises.
Shoe Lifts:
Used for leg length
discrepancies.
Worn in regular
shoes.
Places opposing
pressure on scoliosis
curvatures.
Must be worn during
every scoliosis
radiograph.
Treatment: 25 to 35 degree curve
Day and night brace worn 20+ hours/day.
Bone grafts.
Hardware(metal splints)
Types
Milwaukee
Underarm orthosis
Electrical stimulation
Braces
Successful Bracing
Prevent curve progression
Randomized study
Braced 74% did not progress
Not braced 34% did not progress
Electrical stimulation
33% did not progress
Charleston brace still controversial
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
Treatment Algorithm
Surgery
Failed bracing
Curves >45 degrees
Unbalanced curves >40
degrees
Surgery is fusion with
instrumentation
Surgical Options:
Infantile and juvenile scoliosis:
<8 yrs- instrumentation without fusion.