- Scoliosis is a lateral curvature of the spine that is greater than 10 degrees as measured by x-ray. It can be idiopathic, congenital, or neuromuscular in origin. - Kyphosis is an excessive outward curvature of the thoracic spine that causes rounding of the upper back. It can be caused by factors like posture, arthritis, or vertebral fractures/deformities. - Treatment depends on the severity and cause, but may include bracing, casting, exercises, spinal fusion surgery, or in more severe cases, spinal stabilization surgery. Regular monitoring with x-rays is important to assess progression.

1. SCOILOSIS
KYPHO-SCOLIOSIS
KYPHOSIS

2. NORMAL CURVES OF SPINE
• The normal spine is S-shaped curve when viewed from the
side.
• The shape allows for an even distribution of weight and
flexibility of movement.

3. PRIMARY CURVES:
• 2 curves
• Thoracic and sacral
• Which are present at birth
SECONDARY CURVES
• 2 curves
• Cervical and lumbar
• Develop from supporting the body in an upright position
after young children begin to sit and stand

4. • CERVICAL SPINE:
Curves slightly inward as a backward C-shaped-
lordotic curve.
• THORACIC SPINE:
curves outward, forming a regular C-shape with
opening at the front- kyphotic curve.
• LUMBAR SPINE:
Curves inward like cervical spine has LORDOTIC
backward C-shape.
• SACRAL SPINE: kyphotic curve

5. SCOLIOSIS
• Scoliosis – Greek word meaning “ crooked”
• It is a lateral curvature of the spine in upright
position.

6. • Definition: The Scoliosis Research Society has
defined scoliosis as a lateral curvature of
spine grater than 10 degree as measured
using cobb method on standing radiograph
and often accompanied by vertebral rotation
in the transverse plane and hypo kyphosis in
the sagittal plane.
• The rotation component starts when the
scoliosis become more pronounced. This is
called torsion-scoliosis causing GIBBUS

7. scoliosis
Idiopathic Congenital Neuromuscular

8. • Idiopathic scoliosis : 80% cases represent with it
• Sub classification:
Infantile : develops at the age of 0-3 years.
Juvenile : develops at the of 4-10 years.
Adolescent: develops at the age of 11-18 years.

9. • Congenital scoliosis:
• Results from embryological malformation of one or more vertebrae
may occur in any location of spine
• The vertebral abnormalities cause curvature and other deformities of
spine
• The geometry and location of the abnormalities determine the rate at
which scoliosis progresses as the child grows.

10. • Neuromuscular scoliosis:
• Encompasses scoliosis that is secondary to neurological or muscular
diseases.
• Includes scoliosis associated with cerebral palsy, spinal cord trauma,
muscular dystrophy, spinal muscular atrophy and spina bifida.
• This type of scoliosis generally progresses more rapidly than
idiopathic scoliosis and often requires surgical treatment.

11. CLINICAL FEATURES
• Visible prominence of the posterior chest wall
and scapula on one side.
• The location and extent of primary curve are
noted.
• Uneven shoulders
• Low back pain
• Uneven hip

12. KYPHOSCOLIOSIS
• Kyphoscoliosis is defined as a deviation of
the normal curvature of the spine in the
sagittal and coronal planes and can include a
rotation of the spinal axis.

13. ETIOLOGY
• Etiology Kyphoscoliosis affects about 2% of the people in the United
States
• Mostly young children going through growing spurts Rarely develops
in adults—unless a worsening condition from childhood
• Kyphoscoliosis may also develop in adults from a degenerative joint
condition in the spine

14. • Etiology Associated with the following conditions:
• Congenital connective tissue and skeletal disorders
• Hormonal imbalance Neuromuscular disorders
• Trauma
• Extra spinal contractures
• Bone infections involving the vertebrae
• Metabolic bone disorders Joint disease
• Tumors

15. RISK FACTORS
1. Age
Symptoms of scoliosis often begin during puberty, often between the age of
10 and 18. You might notice your child’s hips are uneven or his/her backpack
straps slide off one shoulder easily. You might also notice your child’s ribs are
uneven.
2. Sex
Both boys and girls can develop signs of scoliosis during puberty, but the
condition affects more girls than boys. Girls are also more likely to require
treatment,
3. Family history of scoliosis
Scoliosis can run in families, but most children with scoliosis don't have a
relative with the condition. That being said, having a parent or sibling with
scoliosis increases a person’s chances of having scoliosis too.

16. BIOMECHANICS
• The anterior growth of the spine causes a rotation of the vertebral
bodies.
• When the vertebral bodies rotate, the spinal shear loads are directed
dorsally.
• Shear loads are directed dorsally even during axial loading. Normally,
shear loads are applied in all directions when under axial loading.
• The redirection of shear loads results in tissues being stressed that
are not normally stressed, leading to increased pain and stiffness.
• Increase in spinal compression in those with scoliosis during upright
standing is seen as a result of the rotation of the vertebral bodies

17. • The abnormal curvature of the spine pulls and strains muscles leading
to some muscles becoming weaker than others.
• The increased strain on certain muscles and decreased strength of
other muscles leads to trunk instability.
• Trunk instability affects other functional activities in those with
scoliosis as it decreases the ability to balance.
• A decreased ability to balance can cause problems when it comes to
quiet standing and gait, amongst other activities.

18. • Muscles are shortened on the concave side and lengthened on the
convex side.
• Increased muscular tone and stiffness can lead to increased pain and
decreased range of motion.
• scoliosis often have a decreased range of motion in the frontal plane
of the pelvis, in the hips, and in the shoulders.

19. COMPLICATIONS
• Cardio complications:
• When the spine shifts out of its proper position, it can create
problems for other structures of the body.
• For example, the abnormal curvatures can push the ribcage against
the patient’s lungs, which can cause problems breathing normally.
• If the ribcage presses against the heart, the heart may have trouble
pumping enough blood.
• Heart failure and lung problems such as infections like pneumonia are
some of the serious complications of scoliosis.

20. • Other complications:
• increased curvature of the spine over time
• back pain
• nerve pain
• mobility problems

21. DIAGNOSIS
• X-RAY: the whole spine is done to assess
the degree of the curve.
• The degree od curve is measured by cobb
angle.
• Based on this curves are categorized into:
Mild (<25 degree)
Moderate (25 -45 degree)
Severe( >45 degree)

22. • Risser sign: skeletal maturity shown by fusion of the iliac apophysis is
an indicator of the end of the growth of spine. This helps in assessing
the progression of infantile scoliosis

23. MANAGEMENT
• Casting:plaster casting instead of bracing to help the infant’s spine
grow into a typical position. The cast attaches to the outside of the
infant’s body, and they will wear it at all times.

24. bracing
Thoracolumbosacral orthosis (TLSO)
Milwaukee brace

25. • Surgical Treatment : spinal fusion
• Conservative therapy consists of:
• physical exercises
• bracing
• manipulation
• electrical stimulation
• insoles.

26. KYPHOSIS
• Is a spinal disorder in which an excessive outward curve of the spine
results in abnormal rounding of the upper back.
• This condition is known as round back or hunch back

27. CAUSES
• Habitual bad posture
• Arthritis
• Rheumatism
• Lung affection
• Neuromuscular weakness
• Degeneration of vertebral bodies & discs
• TB
• Ankylosing spondylitis
• Scheuermann's disease
• Congenital anomalies

28. TYPES
• Round Kyphosis
• Gentle backward curvature of spinal column.
• Caused by disease affecting number of vertebra for
e.g. Senile Kyphosis.
• May be localized to a spinal segment or may be
diffuse.
• Dowager's hump- 5/6 vertebra go for kyphosis.
Mostly seen in elderly and in post-menopausal
women who have osteoporosis.

29. • Angular kyphosis
• A sharp backward prominence of spinal column.
• It may be prominence of only one spinous process
because of collapse of only one vertebral body and may
occur in compression fracture of vertebra. This is called
knuckle.
• There may be kyphosis localized to few vertebrae and is
known as GIBBUS commonly seen in TB or some
vertebral fracture.

30. CLASSIFICATION OF DEFORMITY ACCORDING TO
SEVERITY
1.First degree kyphosis:
• Habitual bad posture is the precipitating factor.
• There is no imbalance between the muscles.
2.Second degree kyphosis:
• Pectoral muscle becomes short, there by restricting chest expansion resulting in
reduced respiratory function.
• Longitudinal back muscle, rhomboids & middle trapezius are weakened with loss
of tone and are in a stretched position.
• Posterior ligament are lengthened with corresponding shortening of anterior
structures.
• This result in posterior laxity.
3.Third degree kyphosis:
• Wedging of vertebral body may occur.
• The deformity gets organized which is a difficult syndrome.

31. POSTURAL ADAPTATIONS IN KYPHOSIS
• Rounded back
• Forward head
• Flattened chest
• Rounded shoulders
• Excessive protrusion of scapula

32. MANAGEMENT:
1.First degree kyphosis
• Relaxation of body especially upper back.
• Repeated stretching session of shortened anterior structures by bracing
shoulder & maintaining position.
• Postural training
• Mobilization of spine, scapula & shoulders.
• Diaphragmatic & costal breathing exercises to emphasize on inspiration.
• Resistive exercise to weak longitudinal & transverse back muscle
• Controlled pelvic tilt associated with abdominal & gluteal contractions.

33. 2.Second degree kyphosis
• Milwaukee brace with pads.
• Exercises to improve mobility and respiration to reduce overall impact
of deformity.
3.Third degree kyphosis
• Bone graft
• Spinal cord depression
• Spinal stabilization

34. THANK YOU