/scoliosis Scoliosis (Orthopedics)
 
Medicine

Scoliosis (Orthopedics)

Concise overview on Scoliosis and its treatment
 

This is defined as the lateral curvature of the spine with vertebral rotation and occurs typically at 10-14 years. It is more frequent and severe in females.

Etiology

90% is idiopathic. Other causes include

  • Congenital - Vertebrae fails to form or segment
  • Neuromuscular - Upper Motor Neuron or Lower Motor Neuron lesions, myopathy
  • Postural - Leg length discrepancy, muscle spasm
  • Other: osteochondrodystrophies, neoplastic, traumatic

Clinical Features

  • +/- back pain
  • Primary curve present (where several vertebrae are present)
  • Secondary curve: above or below primary curve and function to maintain the normal position of the head and pelvis.
  • Asymmetric shoulder height when bent forward
  • Positive Adams test (rib hump when bent forward)

Adams Test: Used to differentiate whether deformity is structural vs functional. The patient is asked to lean forward with arms hanging down. If the posterior thorax is symmetrical, scoliosis is considered functional in origin. If the posterior thorax maintains deformity, the scoliosis is considered structural.

  • Prominent Scapulae, creased flank, asymmetric pelvis
  • Associated posterior midline lesions in neuromuscular scolioses
    • Cafe au Liat spots, dimples, neurofibromas
    • Axillary freckling, hemangiomas, hair patches
  • Associated Pes Cavus (high arched feet) or leg atrophy
  • apparent limb length discrepancy

Investigations

Xray:

  • 3 foot standing, AP, Lateral

3 foot standing view:
* Radiograph from hip to foot with patient in standing position
* Useful in evaluating leg length and genu varus / valgus. Gives idea of how weight bearing deforms feet as well.

-   Measure Curvature: Cobb Angle
-   May have associated Kyphosis

The Cobb angle is the most widely adopted technique to quantify the magnitude of spinal deformities, especially in the case of scoliosis, on plain radiographs. A scoliosis is defined as a lateral spinal curvature with a Cobb angle of 10° or more.

Measurement

To measure the Cobb angle, one must first decide which vertebrae are the end vertebrae of the curve deformity – the vertebra whose endplates are most tilted towards each other.
Lines are then drawn along the endplates, and the angle between the two lines, where they intersect, measured.
In cases where the curvature is not marked, then the lines will not intersect on the film/monitor, in which case a further two lines can be plotted, each at right angles to the previous lines.
Most PACS will have a dedicated angle tool to measure this without needing the lines to intersect or need to add the aforementioned lines at right angles.

 

Cobb angle

 

Treatment

  • Functional: Correct underlying problem
  • Structural: Based on the Cobb angle
    • < 25 degrees - observe for changes with serial radiographs
    • 25 degrees or progressing on serial radiographs: Bracing. These slow or halt progression but do not reverse it.

    • >45 degrees, cosmetically unacceptable or respiratory problem: surgical correction (spinal arthrodesis [artificial fusion])