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Differential Diagnosis : Back Disorders

Spinal Disorders . Congenital OR Acquired :DevelopmentalTraumaticInfectionInflammationTumorDegenerativeMetabolicPsychological. CONGENITAL. May present early with obvious deformity orMay present later accidentally or symptomaticallyUsually Painless. Congenital Anomalies: Sacrali

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Differential Diagnosis : Back Disorders

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    1. Differential Diagnosis : Back Disorders Dr. Munir Saadeddin FRCSE

    2. Spinal Disorders Congenital OR Acquired : Developmental Traumatic Infection Inflammation Tumor Degenerative Metabolic Psychological

    3. CONGENITAL May present early with obvious deformity or May present later accidentally or symptomatically Usually Painless

    4. Congenital Anomalies: Sacralisation

    5. X Ray of incomplete hemi-Sacralisation

    6. X Ray of R Hemi-Sacralisation

    7. X Ray of complete Sacralisation

    8. Lumbarisation

    9. Congenital anomalies : Aetiology

    10. Aetiology Failure of formation : part of ossification centre fails to grow whilst the other part grows so a WEDGE vertebra forms ( anterior or lateral ) Failure of Segmentation : part of ossification center fails to separate from above or below ossification center so a BLOCK vertebra forms

    11. Failure of Formation

    12. Failure of Segmentation

    13. Congenital Kyphosis : Wedge Vertebra

    14. Klipple-Feil syndrome

    15. Klipple-Feil Syndrome Characterised by both failure of formation (Wedge vertebra=congenital scoliosis or kyphosis) Failure of segmentation=Block vertebra Short neck and high scapula are very characteristic

    16. Congenital Scoliosis

    17. Congenital Kyphosis

    18. Scoliosis Many causes: Most common is Idiopathic. Other causes include : congenital, neuropathic (e.g. polio), Myopathic e.g. (muscular dystrophy), connective tissue disease e.g. (Marfan’s syndrome), tumour, trauma, infection ( T.B.)

    19. Idiopathic Scoliosis

    20. Idiopathic Scoliosis is associated with rotation of vertebrae

    21. Scoliosis: Important Points Observation of deformity during back flexion is most accurate Leg length asymmetry is a cause of scoliotic deformity Rib hump elevation may be measured by a scoliometer

    22. Some causes of Scoliosis

    23. X Ray of Idiopathic Scoliosis

    24. Cob’s angle: lateral bending

    25. Principles of Scoliosis management Mild cases< 25 Degrees= Programme of exercise and intermittent traction Between25 and 40 = Orthosis or Plaster of Paris cast >40-50 degrees = consider Surgery

    26. Traction for Scoliosis

    27. Scoliosis: correction with a cast

    28. Scoliosis: Principles of Surgery

    29. Scoliosis : Principles of Surgery Usually extensive surgery Blood transfusion is required Bone graft is always done Correction is done by Instrumentation Either : Posterior Approach ( more common and for less rigid deformities ) Anterior Approach (includes Thoracotomy or Thoracoscopic approaches )

    30. Scoliosis : Principles of surgery Correction is done by release of tight structures, distraction , compression and rotation with instrumentation Instrumentation includes rods, hooks, plates and pedicular screws Bone graft to insure spinal fusion in corrected position is mandatory

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