Review of Spinal Alignment

Normal spinal alignment has been introduced in PTA 101 and reinforced in PTA 133L and PTA 104/104L

  • Spine should be vertically straight
  • Center of occiput should be aligned with center of sacrum
  • Results in normal lordosis (cervical and lumbar curves) and kyphosis (thoracic and sacral curves)
  • Postural abnormalities are identified primarily through observation; decreases or increases in spinal curves at rest are consistent abnormal postural findings

Scoliosis

Scoliosis is any lateral curvature of the cervical, thoracic, or lumbar spine; rotoscoliosis is an updated term that is more specific to the abnormal combined lateral curve with progressive rotation at individual spinal segments

Primary Onset of Scoliosis

  • classified as idiopathic: infantile (0-3yr), juvenile (3-9 yr), adolescent (puberty to adult), or adult
  • congenital - some correlation with family history
  • idiopathic (cause unknown) is the most prevalent form
    • 75%-85% of all recognized types of scoliosis
    • idiopathic adolescent scoliosis comprises about 80% of scoliosis cases
    • R thoracic is the most common
  • neuromuscular causes, such as imbalances in tone, spasticity, or loss of muscle function (paresis and/or paralysis)
  • degenerative disease

Associated Symptoms

  • pain
  • decreased cardiopulmonary function (usually with thoracic curves greater than 65 degrees)
  • decreased digestive function
  • neurological symptoms associated with spinal stenosis.

 

Sample scoliosis progression (Approximately 2 minutes)

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Secondary Onset of Scoliosis

  • osteoporosis
  • trauma (e.g.,, fracture, leg length discrepancy)

Prognosis

  • Prognosis is influenced by:
    • age of onset - Younger age-onset is has a poorer prognosis
    • type of curve - Double curves have a poorer prognosis than single curves
    • degree of curve - the higher the degree, the greater expectations of comorbidities and functional changes. Severity is classified by degree of curve
      • curve <= 25 degrees - monitor for changes
      • curve 25 to <=40 degrees - use of orthotic; physical therapy is recommended
      • curve > 40 degrees may result in surgical stabilization to prevent further progression
    • gender - biological females have a 10 times greater risk for progression

Classifying Scoliosis

Recognized as either structural or nonstructural

  • structural: rotation of the spine is fixed, irreversible; lateral curves do not change with patient position or voluntary movement. The images below are examples of structural scoliosis
  • non-structural: rotation of the spine is reversible; lateral curves are reduced with positional changes

Scoliosis.jpg

Document observation findings to describe the scoliosis. Common documentation elements include:

  • Side of the convexity: e.g. Right thoracic scoliosis
  • Spine involvement: e.g., Right thoracic scoliosis
  • Presence +Adams Forward Bend Test - rib hump during forward flexion indicates structural scoliosis named by side of convexity - direction of rotation

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  • Number of rotation curves - single vs. double