Adolescent Idiopathic Scoliosis

Question 1

What is the most common type of scoliosis?

Answer 1

Adolescent idiopathic; most are right thoracic curves

If left thoracic must get MRI to r/o syrinx or cyst

Question 2

What are risk factors for curve progression in adolescent idiopathic scoliosis?

Answer 2

1) curve magnitude; >25° before maturity will progress; thoracic curves >50° and lumbar curves >40° after maturity will progress
2) Type; thoracic more likely to progress
3) Growth stage;
Risser 0-1
Open triirradiate cartilage
If curve >30° before peak height velocity, risk for surgery

Question 3

How are coronal and sagittal balance of the spine determines?

Answer 3

Coronal- plumb line from C7 to center of sacrum

Sagittal- center of C7 to posterior-superior corner of S1

Question 4

In a patient with adolescent idiopathic scoliosis what is an indication to obtain MRI?

Answer 4

1) Left thoracic curve
2) asymmetric abdominal reflexes
3) rapid progression
4) foot deformities

Question 5

When is non-operative treatment appropriate for adolescent idiopathic scoliosis?

Answer 5

1) Cobb angle 25° but

Question 6

At what angle is surgical treatment indicated in adolescent idiopathic scoliosis?

Answer 6

Cobb >45°

Question 7

What are some basics of posterior spinal fusion for adolescent idiopathic scoliosis?

Answer 7

1) Goal is to correct sagittal and coronal balance while preserving motion
2) Try to avoid fusing to L4 or L5 to decrease back pain
3) Almost never fused to pelvis

Question 8

In a patient with thoracic hyperkyphosis in adolescent idiopathic scoliosis, what is a risk of anterior fusion vs posterior fusion?

Answer 8

Increased risk of pseudoarthrosis

Question 9

What is the Risser classification?

Answer 9

Risser 0: covers the first 2/3rd of the pubertal growth spurt and correlates with the greatest velocity of skeletal linear growth (Girls 11-13, Boys 13-15); no ilium calcification

Risser I: is given when the ilium calcification measures 25%. As this stage the velocity of linear skeletal growth is on a descending slope.

Risser II: the greater trochanteric apophysis unites with the femur and Ilium calcification measures 50%. There is usually 3 cm of sitting growth remaining and no further growth in the lower extremities.

Risser III: Ilium calcification measures 75%. There is usually 2 cm of sitting growth remaining.

Risser IV: Ilium calcification is almost complete. There is usually 1 cm of sitting growth remaining.

Risser V: marks complete skeletal maturation.