(3) Scoliosis Intro

Question 1

What is a scoliosis?

Answer 1

lateral curvature of the spine of 10 degrees or greater

Question 2

What landmarks are used when assessing scoliosis?

Answer 2

• end vertebrae (last vertebrae that contribute to equal or greater curve)
• apical vertebra (most lateral vertebra)

Question 3

In a scoliosis, a secondary curve is also called a ____ curve

Answer 3

compensatory

Question 4

What is a major curve in a scoliosis?

Answer 4

the larger(est) curve(s), usually in a structural scoliosis

Question 5

What is a minor curve in a scoliosis?

Answer 5

the smaller(est) curve(s)

Question 6

What is a primary curve in a scoliosis?

Answer 6

the first or earliest of several curves to appear, if idientifiable

Question 7

What is a secondary curve in a scoliosis?

Answer 7

a curve above or below the primary curve, functioning as an adaptation to the primary curve and maintaining normal body alignment
(may be structural)

Question 8

What is a double major scoliosis?

Answer 8

a scoliosis with 2 structural curves occurring in different spinal areas

Question 9

What is a double primary scoliosis?

Answer 9

a scoliosis with 2 curves occurring in 1 spinal area

Question 10

What side is a scoliosis named for?

Answer 10

convexity

Question 11

What methods may be used for clinical evaluation of scoliosis?

Answer 11

• screening of adolescents
• standing postural evaluation
• Adam test
• side bending
• imaging

Question 12

What orthopedic test is used to assess structural versus functional scoliosis?

Answer 12

Adam test

Question 13

What is the standard method of determining structural versus functional scoliosis?

Answer 13

imaging
(radiographs preferred, MRI/CT follow-up if needed)

Question 14

What is the concern for imaging of adolescent idiopathic scoliosis (AIS)?

Answer 14

• average 22 torso radiographs
• 110% increase in breast cancer over general population

Question 15

What is the purpose of initial radiography of scoliosis?

Answer 15

• confirm presence of scoliosis
• quantify scoliosis
• determine possible etiologies

Question 16

What radiographic view is used for initial imaging of scoliosis?

Answer 16

AP
(must be weight bearing)

Question 17

What radiographic view is used for follow-up imaging of scoliosis?

Answer 17

PA
(must be weight bearing)

Question 18

What state of the art imaging modality is used for follow-up imaging of scoliosis?

Answer 18

EOS imaging
(high quality, low dose; changes radiation level at each segment)

Question 19

What is the gold standard measurement for quantifying scoliosis?

Answer 19

Cobb angle
(angle between end vertebrae)

Question 20

What method is used to assess rotation of scoliosis?

Answer 20

Nash Moe method (using pedicles)

Question 21

What radiographic view should never be used for scoliosis (or ever)?

Answer 21

lateral full spine

Question 22

What are the possible structural etiologies of scoliosis?

Answer 22

*must R/o in this order:
- congenital
- developmental
- neuromuscular
- tumor-related
- degenerative
- idiopathic

Question 23

What are the possible functional etiologies of scoliosis?

Answer 23

• spasm/antalgia
• muscle imbalance
• leg length inequality

Question 24

What is the Hueter-Volkmann principle?

Answer 24

in developing vertebrae:
- portions under compressive load slow growth (concave)
- portions under tensile load accelerate growth (convex)
Resulting in structural wedging of vertebrae

Question 25

When describing a scoliosis, what information must be included?

Answer 25

side, region, "scoliosis"

Question 26

What radiographic organ shadows occur on the right side of the body?

Answer 26

liver

Question 27

What radiographic organ shadows occur on the left side of the body?

Answer 27

- heart - meganblasse (stomach gas)

Question 28

What is meant by functional scoliosis?

Answer 28

curves that have a mechanical cause, which are flexible with lateral bending

Question 29

What is the threshold of significance for anatomical leg length inequalities (LLI) generating MSK pain?

Answer 29

10mm

Question 30

What screening tool can be used for anatomical leg length inequalities (LLI)?

Answer 30

AP lumbars including the femoral heads

Question 31

If there is concern for an LLI, what follow-up imaging should be ordered?

Answer 31

scanogram (measures each segment of leg to determine cause)

Question 32

What is the only type of scoliosis with recommended follow-up imaging?

Answer 32

adolescent idiopathic scoliosis

Question 33

What is the recommended time frame for follow-up imaging of adolescent idiopathic scoliosis?

Answer 33

- if Risser grade 0-1, then 4-6 months - if clinical findings of progression, image sooner - if higher maturation (grade 2-3), 6-12 months - no further imaging once skel. mature, except over 30 degrees, then every 5 yrs

Question 34

What is the management for scoliosis under 20 degrees?

Answer 34

- monitor - repeat radiographs every 4-12 months depending on skel. maturation

Question 35

What is the management for scoliosis of 20-40 degrees?

Answer 35

Bracing (Boston or Milwaukee)

Question 36

What degree of scoliosis may be managed with bracing?

Answer 36

- 20-40 deg - if 0-20 deg curve progresses 5 deg or greater during an interval

Question 37

What is the purpose of scoliosis bracing?

Answer 37

to prevent **progression** (does not correct curvature)

Question 38

What is the management for scoliosis of 40 degrees or greater?

Answer 38

surgical correction & fusion (pedicle screws & contour rods)

Question 39

What degree of scoliosis may be management with surgical correction?

Answer 39

- 40+ deg - if 20-40 deg curve progresses 5 deg or greater during an interval