1. *-*Physiology Presentation*-*
SCOLIOSIS
GROUP MEMBER:
•RASYIDAH
•RAFI
•MIZA
•FADHLIN

2. History of Scoliosis
• The term scoliosis comes from a Greek word
meaning "crooked.“
• The disease affects the spine, causing it to
curve into an S-shape.
• The spine may also, in some severe cases, be
rotated.
• The disease has existed for centuries, and with
each passing century, human understanding
and treatment for the condition has improved.

3. Classification of Scoliosis
Congenital scoliosis
Idiopathic scoliosis
Neuromuscular
scoliosis
Postural scoliosis
Syndromic scoliosis.

4. Congenital scoliosis
• Congenital scoliosis means that the person
affected is born with scoliosis.
• This type of scoliosis is caused by abnormality
in one or more vertebrae which means they
fail to form properly.
• This condition is obvious when seen on an X-
ray or in operating room.

5. Idiopathic scoliosis
• Idiopathic scoliosis is the most common form of
scoliosis. Idiopathic is defined as “of unknown
cause”.
• Usually the person that has this type of scoliosis
is living healthily and normally. The abnormality
does not show on an X-ray or during direct
observation in operating room.
• The occurrence is equal in female and male, but,
however, severe idiopathic scoliosis is six to seven
times more common in females.

6. Neuromuscular scoliosis
• Neuromuscular scoliosis affects people
suffering from nervous system ailments such
as poor muscle control, muscle weakness, or
paralysis due to cerebral palsy, muscular
dystrophy, spinal bifida or polio.

7. Postural scoliosis
• Postural scoliosis, also called hysterical
scoliosis may result from pain as patient tends
to tilt to relieve their pain.
• It can be solved by relieving the pain or by
lying flat on a surface.
• In this condition, the vertebrae do not show
any abnormality on an X-ray.

8. Syndromic scoliosis
• Syndromic scoliosis occurs in people with
Marfan Syndrome.

9. Signs and symptoms of scoliosis
Uneven
musculature on one
side of the spine
Uneven shoulder
height
Uneven hips/leg
lengths
Slow nerve action
(in some cases)
Head is not
centered directly
above the pelvis

10. Uneven
musculature on
one side of spine
Uneven hip,
shoulders
Head is not
centered directly
above the pelvis

11. Diagnosis,,,
• A standard exam that is often used by pediatricians and in initial
school screenings is called the Adam's Forward Bend Test.
• For this test, the patient is asked to lean forward with his or her feet
together and bend 90 degrees at the waist. The examiner can then
easily view from this angle any asymmetry of the trunk or any
abnormal spinal curvatures. It should be noted that this is a simple
screening test that can detect potential problems, but cannot
determine accurately the exact severity of the deformity.
• Once suspected, scoliosis is usually confirmed with an x-ray, spinal
radiograph, CT scan, MRI or bone scan of the spine.
• The curve is then measured by the Cobb Method and is discussed in
terms of degrees.
• Generally speaking, a curve is considered significant if it is greater
than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are
considered severe and often require more aggressive treatment.

12. Adam’s Forward Bend Test

13. Causes of scoliosis
Genetics
Structural Elements of the Spine or muscle
(connective tissue disorders, muscle disorders) related with
the formation of the spine bones (vertebrae) or fused ribs
during development in the womb or early in life.
Damaged of connective tissue- Marfan Syndrome

14. Pathophysiology of Scoliosis
• In most cases, scoliosis is painless. However, it
can become more severe if left untreated,
resulting in chronic back pain.
• In young children, severe cases can cause
deformities, impair development and be life-
threatening.
• It often worsens during children and teen period.
Scoliosis patients who wear a back brace over an
extended period of time can usually prevent
further curvature of the spine.

15. Effects of scoliosis
Initial effect
• In children, does not cause any pain such as back pain.
• Main symptoms are uneven shoulder blades and waist.
• But, if not treated, it can become worse.
Arthritis
• Because the spine becomes abnormally curved side to side as a result of scoliosis, it can
lead to the joints between the vertebrae becoming damaged.
• This can lead to chronic back arthritis, which can be painful and difficult to treat.
Kyphosis and
deformity
• If scoliosis goes untreated, the spine can continue progress from being curved to being
fully twisted.
• This condition, known as ‘kyphosis’, can result in permanent deformity (with the patient
always appearing hunched).
• It will definitely affect the patient’s condition as it is very painful

17. •In severe cases, scoliosis can cause the spine to
twist to the point that it alters the location of
the rib cage, causing it to be twisted around the
body.
•This can lead to the ribs preventing the lungs
from fully expanding, making breathing difficult.
•It can also lead to a rapid heart rate and
frequent shortness of breath.
Breathing
restriction
•Scoliosis can cause patients to have their hips at
different levels
•Thus, it can cause alterations in the way they
walk and stand.
•The primary change is that the patients with
scoliosis have a more limited range of motion
while they are walking, leading to them
expending more energy and having a stiffer
manner of walking than normal.
Gait
changes
(manner of
walking)

18. Treatment of scoliosis
Option 1: Do
nothing
Option 2:
Wear a brace
Option 3:
Surgery

19. Option 1: Do nothing
• May be a reasonable decision depending on the
age of the person and the predicted outcome.
• If the person is a teen or pre-teen and the
prediction is that this curve will worsen then
doing nothing may not be appropriate.
• This is because increasing curves usually give an
increase in the deformity that is the chest twists
throwing the shoulder blade off in back causing a
rib hump.

20. Option 2: Wear a brace
• Pros =) Bracing has been shown to be an effective method to prevent
curves from getting worse.
• From a practical aspect, this treatment is reserved for children and
adolescents in whom the prediction of a rapid increase in the curve
needs to be prevented.
• A brace worn 16 or more hours per day has been shown to be effective
in preventing 90% or more of the curves from getting worse.
• Cons =( A back brace does not reverse the curve. Instead, it uses
pressure to help straighten the spine. The brace can be adjusted with
growth
• The brace is hot, hard, uncomfortable, ugly and while it normally can't
be seen under the clothes definitely makes a teenager more self-
conscious.
• It also seems to create problems of when to put it on, when to take it
off, and for how long to wear it.

22. Option 3: Surgery
• Usually surgery is reserved for teen and pre-teens who
already have a curve around 40 degrees or more.
• In the adult age range the reasons for doing surgery are
less well defined but include an increasing discomfort
or pain in a curve that appears to have increased.
• For many women the deformity in the hip line and the
increasing discomfort combine to make surgery a
reasonable option.
• Surgery however is a big deal and not to be undertaken
lightly (high risk).

23. SURGERY….