Dr.

Tehreem Nasir
TORTICOLLIS
Persistent neck deviation
to one side
 Stressand emotional events
may exacerbate symptoms
 Women effected more often
than men (4.5:1)
 May occur in children or adults
 Congenital Torticollis
 Infants appear healthy at delivery
 Over days to weeks, soft-tissue swelling appears over an injured
sternocleidomastoid, Injury may be due to birth trauma or
intrauterine malpositioning.
 Mass gradually regresses and leaves a fibrous band in place of
the sternocleidomastoid muscle, causing contracture of the neck.
 Acute Torticollis
 May be due to number of underlying conditions such as Trauma
 Develops overnight
 Young and middle-aged adults.
 Painful neck spasms with tenderness
 Symptoms usually resolve spontaneously within 2 weeks
 Treatment: Heat, massage, supportive cervical collar,
muscle relaxants, and analgesics
 Idiopathic Spasmodic Torticollis
 No clear etiology, although a lesion of the thalamus has been
suspected
 A type of focal dystonia (ie, dystonic movements in a single body
part)
 Diagnosis
• Plain cervical
radiograph
• MRI
• CT scan
• Clinical examination
 Provide opportunities to
baby to turn head to the  Immobilization after
affected side trauma
 Stretching and  Analgesics, muscle

lengthening exercises by relaxants, anxiolytics

 Botulinum toxoid
physiotherapist
 Full recovery in 85%
injection
cases by 1 year of age  Chiropractic care,
 Remaining will need
massage, orthotic
orthopedic consultation collar, alternative
and possibly surgery medicine
SCOLIOSIS
Scoliosis
 Lateral curvature of spine
 Generally, a sideways curvature greater than 10 degrees is considered
scoliosis
 As the spine curves, the vertebrae rotate, pulling the ribs along
 Types

 Etiological types are

 Congenital

 Juvenile

 Neuromuscular

 Idiopathic
Congenital Scoliosis

 Embryologic malformation of spine

 Localized or generalized deformity

 Hemivertebra
 Rib fusion
 Neuromuscular Scoliosis

 Secondary to neuropathic disorders (Poliomyelitis, Cerebral

palsy, Myelomeningocele)
 Initially flexible, gragually becomes rigid

 Long generalized C-curvature with severe muscle weakness

 Infantile Idiopathic Scoliosis Juvenile Idiopathic
Occurs in first 3 years of life


 Associated with intrauterine malposition

Scoliosis
 Boys are affected more  Uncommon
 Usually left thoracic curve is seen  Between ages 4 and 10years
 Associated with mental deficiency or other congenital  Right thoracic curve
skeletal deformities
 Self limiting, spontaneously resolves in majority  Both sexes equally affected
 Worse prognosis
 Surgical correction before puberty

Adolescent Idiopathic Scoliosis

 Between ages 10 and 16years
 Seven times more common in girls
 Fairly common
 Majority with left lumbar curved
 Curves under 20 degrees either resolve spontaneously or remain unchanged
Clinical features Diagnosis
 Mild lower back pain  Spinal X rays
 Neck pain, Headache  MRI
 Premature disc and joint  Curve measurements
degeneration  Pulmonary function tests
 Decreased pulmonary functions
 Psychological effects
Treatment
 Observation
 Orthotics (Braces)
 Traction and Casting
 Exercises

 Surgery (Fusion or Implants)

 For curves greater than 40 degrees
KYPHOSIS
 Kyphosis
 Curving of spine that causes a bowing or rounding of the back, which leads to a
hunchback or slouching posture
 Three main types
1. Postural kyphosis
2. Scheuermann’s kyphosis
3. Congenital kyphosis
4. Other Causes:
◼ Certain endocrine disorders
◼ Connective tissue disorders
◼ Infection
◼ Muscular dystrophies
◼ Poliomyelitis
◼ Spina bifida
◼ Tumors
Postural Kyphosis Congenital
 Most common type
 Noticed in adolescents, Girls Scheuermann’s Kyphosis
more than boys Least common type
Caused by poor posture and
Kyphosis 

  Caused by abnormal
weakening of paraspinous  Noticed in adolescents development of vertebra
muscles, ligaments in the back  Result of structural deformity prior to birth
 Progressively gets worse with Commonly develops with
time
  Occurs due to fusion of
scoliosis many vertebra
 Symptoms: Pain and muscle
fatigue
Clinical Features Diagnosis
 Difficulty in breathing (only in  Clinical assesment
severe cases  X-ray spine
 Fatigue  MRI
 Back pain  Pulmonary function
 Tenderness and stiffness tests
 Round back appearance
(Cosmetic concerns)
Management Complications
 Postural kyphosis  Decreased lung capacity
 Lifestyle modification, Exercises  Disabling pain
 Congenital kyphosis  Neurological symptoms (weakness
and paralysis of lower limbs)
 Surgery at early age
 Round back deformity
 Scheuermann’s kyphosis
 Braces and physical therapy
 Tumors
 Surgical resection
LORDOSIS
 Lordosis
 Natural curve of spine in the
cervical and lumbar regions
 Exaggeration of this curve
is called lordosis
 Pain and discomfort, limited
mobility
 Common Causes

 In Adults  In children
 Spondylolisthesis  Hip dislocation
 Osteoporosis  Cerebral palsy

 Muscular dystrophies
 Osteosarcoma
 Spinal muscular atrophy
 Obesity

 Pregnancy
Types Symptoms
 Postural lordosis (In Pain
obese individuals) Muscle spasm
 Congenital/Traumatic
Limited movement
lordosis
Involvement of limbs
 Post-surgical
 Numbness
Neuromuscular lordosis  Tingling

 Electric shock like pain

 Weak bladder control

 Muscle weakness
Diagnosis
 History and examination
 Plain radiographs of Cervical/Lumbar spine

Treatment
 Most people don’t need
treatment
 Analgesics
 Physiotherapy

 Weight loss

 Braces
 Nutritional supplement
 Surgery
FLATBACK
The natural curve of human is like a soft
‘S’. The spine has an inward-outward-
inward curve at the upper, middle and
lower back, when viewed from the side.
These natural curves help in the even
distribution of weight and impart
flexibility to movements.

Flatback Syndrome is an abnormal

spine condition where spine in the
lower back loses its natural curves and
becomes flat over time. It creates spinal
imbalances causing the patient to lean
forward, over time making it difficult to
stand upright causing back or even leg
Causes of Flatback Syndrome:
• Degenerative Disc Disease
• Ankylosing Spondylitis
• Post-Laminectomy Syndrome
• Vertebral Compression Fractures

Flatback SyndromeSymptoms
Some of the other common symptoms one must look out for are:
1. Head leaned forward and feeling of falling forward.
2. Prolonged pain in the back muscles, shoulder or neck.
3. Fatigue & posture issues
4. Muscle weakness and inability to stand or walk for a longer duration.
Diagnosis
• Medical history – incidence of back surgery and spinal deformities
• Musculoskeletal examination
• Neurological examination
• Gait exam to assess walking
• X-ray to analyse the changes and visualize the sagittal alignment respectively.
Treatment
• Conservative treatment for Flatback Syndrome starts with
Physical therapy and exercises which include strengthening
and stretching exercises for better mobility, movement,
improved posture and muscular imbalance correction.
In rare cases, spine surgeries like Wedge osteotomy
THANK YOU
Dr.Tehreem Nasir
MBBS, RMP