5. TRATAMIENTO
CONSERVADOR
OBJETIVOS:
• DESARROLLAR UNA CONCIENCIA POSTURAL EN EL NIÑO Y ENSEÑARLE A MANTENER
UNA ALINEACIÓN POSTURAL CORRECTA.
• MANTENER UNA RESPIRACIÓN Y MOVILIDAD TORÁCICA APROPIADAS.
• CONSERVAR LA FUERZA MUSCULAR, EN ESPECIAL LOS RECTOS ABDOMINALES
INFERIORES, LOS GLÚTEOS Y LA MUSCULATURA PARAVERTEBRAL.
6. • CONSEGUIR UN BUEN GRADO DE MOVILIDAD Y
FLEXIBILIDAD DEL RAQUIS.
• RETORNAR A LOS NIVELES DE ACTIVIDAD FUNCIONAL
ANTERIORES AL USO DE ORTESIS, ENSEÑÁNDOLE A
MOVERSE, CAMINAR, CORRER Y DESARROLLAR SUS
ACTIVIDADES MIENTRAS UTILIZA EL CORSÉ.
• FAVORECER EL EFECTO DE LAS FUERZAS DE CORRECCIÓN
PASIVA DEL CORSÉ, CONSIGUIENDO, ASIMISMO, UNA
CORRECCIÓN ACTIVA DENTRO DEL MISMO
7. LA REVISIÓN PERIÓDICA (CADA 3 Ó 6 MESES): MEDIANTE EXPLORACIÓN FÍSICA Y LA
RADIOLOGÍA ESTÁ INDICADA EN EI EN FASE DE CRECIMIENTO VERTEBRAL, EN CURVAS
MENORES DE 20° O EN MAYORES DE 20° SI EL RIESGO DE PROGRESIÓN ES BAJO.
ALVAREZ GARCIA DE QUESADA, L.I. y NUNEZ GIRALDA, A.. Escoliosis idiopática.Rev Pediatr Aten Primaria [online]. 2011, vol.13, n.49, pp. 135-146. ISSN 1139-
7632.
8. TRATAMIENTO ORTOPÉDICO CORSÉS
INDICACIONES
• CURVAS >25º-30º TODAS
• CURVAS <25º CON DATOS DE EVOLUTIVIDAD Y CON FACTORES DE RIESGO
9. OBJETIVOS
• FRENAR EVOLUCIÓN DURANTE PERIODO DE CRECIMIENTO RESTANTE: CURVAS
LEVES Y MODERADAS PARA EVITAR LA CIRUGÍA.
• DIFERIR LA CIRUGÍA HASTA EL MOMENTO ADECUADO EN
CURVAS INFANTILES Y JUVENILES SEVERAS.
• REDUCIR Y MODELAR LOS DEFECTOS MORFOLÓGICOS (GIBOSIDAD)
10. Uso a tiempo completo 23h/día, 16 h /día o nocturno
Los + efectivos: los usados 23 h/día.
Seguimiento vigilar que el corsé esté bien confeccionado, adaptado y
realice la función de contención que se pretende.
Retirada cuando se detiene el crecimiento vertebral
11.
12. EJERCICIOS
KLAPP
• Cambio postural
• Posturas de estiramiento asimétrico son usadas
para
• Fortalecimiento muscular
• Estiramiento del lado cóncavo
13.
14. CIRUGÍA
• Corregir y mejorar la deformidad
• Mantener el balance sagital
• Mejorar la función pulmonar
• 40 a 50°
INDICACIONES
• Deformidad severa >50° con asimetría del tronco
• Dolor no controlado con Tx. Conservador
• Lordosis Torácica
• Deformidad cosmética significativa
significant improvements in the lumbar curvatures, but no significant results in the thoracic scoliosis. On the other hand, Ribeiro and Ribeiro27 treated six subjectsapplying 20 sessions of the Klapp method which resulted in the reduction of the thoracic curvatures, and was also assessed by radiography.
not show good results, and was also innefective to address the alignment of the knees in the sagittal plane.
INDICACIONES:■ Increasing curve in growing child
■ Severe deformity (>50 degrees) with asymmetry of trunk in adolescent
■ Pain uncontrolled by nonoperative treatment
■ Thoracic lordosis
■ Significant cosmetic deformity
SURGICAL GOALS
The goals of surgery for spinal deformity are to correct or to improve the deformity, to maintain sagittal balance, to preserve or to improve pulmonary function, to minimize morbidity or pain, to maximize postoperative function, and to improve or at least not to harm the function of the lumbar spine. To accomplish these goals in patients with idiopathic scoliosis, surgical techniques may include anterior, posterior, or combined anterior and posterior procedures. The surgical indications, techniques, and procedures are divided into anterior and posterior sections.
Surgery
Surgical treatment is indicated for the majority of patients with infantile or juvenile idiopathic scoliosis and in selected patients with AIS, when other methods of treatment have failed to control the deformity, and when further progression would be expected to result in unacceptable cosmesis and/or physiologic abnormalities. Such deformities are typically treated by a definitive spinal arthrodesis (fusion). The majority of progressive infantile and juvenile curves ultimately require a spinal arthrodesis, and the goal is to delay the definitive procedure until the pulmonary system and thoracic cage have matured and the trunk height has been maximized.
An alternative strategy is required for curvatures that progress despite bracing. In some centers, serial casting under general anesthesia is employed for selected infantile and juvenile curves to gain correction into a “braceable” range, followed by application of a spinal orthosis. The other option for progressive curvatures is a “growing rod” construct. A spinal rod (or 2 rods) is attached to anchors at the top and at the bottom of the curvature, and distraction forces are applied to achieve correction. The rods hold the spine in the corrected position, and they must then be lengthened every 6 months to maintain correction. Many curves have been controlled for years using such a protocol, and definitive fusion is delayed until a more optimal age.