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Scoliosis
From WikiSM
Contents
Other Names
- Adolescent Idiopathic Scoliosis (AIS)
- Juvenile Scoliosis
- Infantile Scoliosis
- Degenerative Scoliosis
Background
- This page refers to all forms of scoliosis, including pediatric and adult forms
- Definition: spinal deformity of the normal vertical line of the spine
- Consists of a lateral curvature with rotation of vertebrae within the curve
- Typically requires at least 10° spinal angulation on the posterior-anterior radiograph
History
Epidemiology
- Prevalence in adults ranges from 2% to 32%[1]
- The prevalence of degenerative scoliosis ranges from 6% to 68%[2]
- Idiopathic
- Most common, prevalence of 1-3 per 100 person-years[3]
Pathophysiology
- Congenital
- Vertebral abnormality causing the mechanical deviation of the normal spinal alignment
- Failure of formation or a failure of segmentation (or both) during vertebral development
- Often co-occuring with other congenital abnormalities
- Neuromuscular
- Neurological conditions: cerebral palsy, paralysis
- Muscular abnormalities: Duchenne muscular dystrophy
- Syndrome-related
- e.g. Marfan syndrome, neurofibromatosis
- Idiopathic
- Majority of cases, diagnosis of exclusion
- After skeletal maturity, found that curves less than 30° do not progress, while most curves of greater than 50° continue to progress
- Progression is estimated to be 1° per year
- Adolescent Idiopathic Scoliosis (AIS)
- Present after 10 years of age which corresponds with rapid adolescent growth[4]
- Risk factors for progression: female gender, curve magnitude of greater than 50° at maturity, curve type and remaining growth
- Degenerative
- Refers to progressive degeneration of structural spinal elements
- asymmetric degeneration of intervertebral disc, facet joints at different levels leading to asymmetric loading of the spinal segment
- Due to secondary reasons
- Widely varied including pain, spinal cord pathology, neoplasm, infection
Risk Factors
- Genetic[5]
- 7 fold more likely if sibling has
- 3 fold more likely if parent has
- Osteoporosis
Differential Diagnosis
- Fractures
- Neurological
- Musculoskeletal
- Autoimmune
- Infectious
- Pediatric
Clinical Features
- General: Physical Exam Back
- Red flags for non-idiopathic causes[6]
- Age at onset
- Evidence of maturation
- Presence of back pain
- Neurological symptoms, including gait abnormalities, weakness or sensory changes
- Feelings about overall appearance and back shape
- Family history
- History
- Patients report spinal deformity, chest wall or back asymmetry
- Deformities may be identified by parents, school, physician screening
- Women may notice difference in breast size
- Back pain is not unusual, but not typically a presenting symptom in kids[7]
- Adults present with back pain 90% of the time
- Must screen for neuro symptoms: weakness, sensory changes, problems of balance, gait and coordination, bowel and bladder dysfunction
- Physical Exam
- Pediatrics: height, puberty development
- Proper gait evaluation
- Symmetry of shoulders, iliac crest, leg length
- Thorough neurological exam
- Special Tests
- Adams Forward Bend Test: observe for asymmetry of spine with patient bent forward
Evaluation
Radiographs
- Standard Long Spine Radiographs
- Evaluate curve in the coronal plane
- Rotational deformity (absence of rotational deformity is a red flag)
- Cobb Angle
- Measured by marking perpendicular lines to the end plates of the most angulated vertebrae involved in the curve
MRI
Classification
Lenke Classification of AIS
- 1. Label primary curve at Type 1-6
- 2. Assign lumbar modifier (A,B,C)
- 3. Assign sagittal modifier (-,N,+)
Aebi Classification of Adult Scoliosis
- Type 1: Primary degenerative or "de novo" scoliosis [8]
- Often due to disc and/or facet joint arthritis, affecting those structures asymmetrically
- predominantly back pain symptoms, often accompanied either by signs of spinal stenosis
- Type 2: Idiopathic adolescent scoliosis of the thoracic and/or lumbar spine
- Progresses in adult life, usually combined with secondary degeneration and/or imbalance.
- Type 3: Secondary adult curves
- (a) Secondary curve in idiopathic, neuromuscular and congenital scoliosis, or asymmetrical anomalies at the lumbosacral junction;
- (b) Metabolic bone disease combined with asymmetric arthritic disease and/or vertebral fractures.
Management
Screening
- School based screening is controversial
- Scoliosis Research Society (USA) recommends annual screening of all children between 10 and 14 years of age[9]
- American Academy of Pediatrics has recommended screening with the forward bending test at routine health supervision visits at 10, 12, 14 and 16 years of age[10]
- US Preventive Services Task Force, Canadian Task Force on the Periodic Health Examination: insufficient evidence to recommend for or against routine screening of asymptomatic adolescents for idiopathic scoliosis[11][12]
- Concern about routine screening is identifying asymptomatic cases who are subsequently referred for sub-specialty care unnecessarily
Prognosis
Nonoperative
- The treatment of scoliosis is based on:
- Type of scoliosis
- Magnitude of the curve
- Number of years of growth remaining
- Patient’s opinion about the shape of their back
- Goal is to keep curve under 50°
- Curve <25°: Observe
- Curve 25-50°: Orthosis
- Corrective Spinal Orthosis
- Including Milwaukee brace, Boston brace and the Charleston bending brace
- Goal is not to improve brace but prevent progression[13]
- Analgesics including NSAIDS, Acetaminophen
- Consider Gabapentin
- Physical Therapy
- Aquatic Therapy
- Spinal Manipulation Therapy
- Yoga
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Procedures
- Epidural and facet injections
- Nerve root blocks
- Trigger Point Injection
Operative
- Consideration/ Indications:
- Curves greater than 45° in immature patients
- Curves greater than 50° in mature patients
- Goals
- Prevent progression
- Improve spinal alignment and balance
- Technique
- Anterior fusion
- Posterior fusion
Rehab and Return to Play
Rehabilitation
Return to Play
Complications
- Back pain
- Cor Pulmonale
- Right Heart Failure
- Diminished pulmonary function
- Psychosocial issues
See Also
- Internal
- External
- Sports Medicine Review Back Pain: https://www.sportsmedreview.com/by-joint/back/
References
- ↑ Aebi M. The adult scoliosis. Eur Spine J 2005; 14(10):925–48.
- ↑ Anasetti F, Galbusera F, Aziz HN, Bellini CM, Addis A, Villa T. et. al,. Spine stability after implantation of an interspinous device: an in vitro and finite element biomechanical study. J Neurosurg Spine 2010;13(5):568–75.
- ↑ Kane WJ, Moe JH. A scoliosis-prevalence survey in Minnesota. Clin Orthop Relat Res. 1970;69:216–8.
- ↑ Morrissy RT, Weinstein SL. Lovell and Winter’s Pediatric Orthopaedics. Philadelphia: Lippincott Williams & Wilkins; 2006. pp. 693–762
- ↑ Wynn-Davies R. Familial (idiopathic) scoliosis. A family survey. J Bone Joint Surg Br. 1968;50:24–30.
- ↑ Joseph A Janicki, MD, Benjamin Alman, MD FRCSC, Scoliosis: Review of diagnosis and treatment, Paediatrics & Child Health, Volume 12, Issue 9, November 2007, Pages 771–776
- ↑ Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8
- ↑ Aebi M. The adult scoliosis. Eur Spine J. 2005;14(10):925‐948. doi:10.1007/s00586-005-1053-9
- ↑ Scoliosis Research Society. Park Ridge: Scoliosis Research Society; 1986. A handbook for patients.
- ↑ American Academy of Pediatrics. Elk Grove Village: American Academy of Pediatrics; 1988. Guidelines for health supervision II.
- ↑ US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd edn. Washington DC: Office of Disease Prevention and Health Promotion; 1996.
- ↑ Canadian Task Force on Periodic Health Examination. Canadian guide to clinical preventive care. Ottawa: Canada Communication Group; 1994. pp. 346–54.
- ↑ Willers U, Normelli H, Aaro S, Svensson O, Hedlund R. Long-term results of Boston brace treatment on vertebral rotation in idiopathic scoliosis. Spine. 1993;18:432–5.
Created by:
John Kiel on 17 June 2019 16:43:44
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Last edited:
5 October 2022 23:58:37
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