Idiopathic Scoliosis

Question 1

Definition and Summary

Answer 1

Idiopathic Scoliosis is the condition where the spine has a lateral curvature usually Cobb angle > 10 degees on Xray that has no organic underlying cause.
The curvature is often present with simultaneous rotation of the involved vertebrae.

Divided by age of incidence and by type of curvature present. Most common is the Adolescent idiopathic scoliosis between ages 10 to 12.

Question 2

Epidemiology

Answer 2

Disproportionately affects girls more than boys 5:1

Question 3

Red Flags aka non-idiopathic scoliosis signs to look out for

Answer 3

The following signs suggest an undelying agents causing scoliosis and/or signs that indicated risk of progression to worsening of scoliosis

• Age < 10 years old [early-onset scoliosis]
• Levocurvature of Thoracic spine
• Rapid onset of new scoliosis or rapid worsening of previous stable curvature
• Severe back pain [usually back pain is minimal or absent]
• High-arched feet, gait instability, arachodactyly, joint laxity
• Incontinence, weakness [focal neuro deficits]
• Cafe-au-lait spots, sacral dimpling and/or sacral tuft [suggestive of neuromuscular scoliosis]
• Systemic symptoms

Possible Etiology of Non-idiopathic Scoliosis:
- Congenital Scoliosis
- Neuromuscular Scoliosis [Cerebral palsy; MD; Spina bifida; Friedreich Ataxia]
- Syndromic Scoliosis [Marfan Syndrome; Ehlers Danlos; Osteogenesis imperfecta; Neurofibromatosis type 1]
- Functional Scoliosis [not caused by structural abnormalities - leg length discrepancy, trauma, tumours, poor posture, pain, muscle spasms, muscle weakness]
- Spinal tumours
- Spinal infections
- Metabolic disease [like rickets]
- Adults Degenerative Scoliosis

Question 4

Classification

Answer 4

By Age:
Infantile Idiopathic Scoliosis:
- 0-3 years of age
- Often Left convex thoracic curvature
- Usually resolves spontaneously

Jeuvenile Idiopathic Scoliosis:
- 4-9 years of age [girls>boys]
- Levocurvature in < 6; Dextrocurvature > 6 in most children
- Surgery in Cobb angle > 30 degrees at puberty start
- Risk of progression is present

Adolescent Idiopathic Scoliosis:
- 10-18 years of age [girls>boys]
- Most common subtype of scoliosis
- Usually Right convex thoracic curvature

Adult Idiopathic Scoliosis:
- Persistence of progression of childhood idiopathic scoliosis

By Location:
- Cervical [C2-C6]
- Cervicothoracic [C7-T1]
- Thoracic [T2-T11]
- Thoracolumbar [T12-L1]
- Lumbar [L2-L4]
- Lumbosacral [L5 or below]

Question 5

Diagnosis

Answer 5

• Focused history and Physical Exam [Tanner stage and Age at menarche to determine growth potential; finding red flags of scoliosis]
• Inspection involving Adam Forward Bent Test preferably with Scoliometer measurements
• Xrays [for Abnormal inspection results’ scoliometer shows > 5 degree angle of trunk rotation]
• MRI spine for suspected non-idiopathic scoliosis

Adam Forward Bent Test will usually show rib hump or lumbar humps on the convex side of scoliosis, patient bends down to reach toes with knees extended, arms straight and palms touching

Question 6

Management

Answer 6

Observation:
- Cobb angle between 10-24 degrees
- Indicated for patients with no determined undlying cause
- Observe every 6 months with physical exam and.or xrays until no remaining growth potential left in child
- Intervention when progression is seen

Interventions:
- Bracing [Cobb angle 25-45 degrees in children with growth potential; Rigid thoracolumbar orthosis for > 13 hours a day +/- physical therapy]
- Surgery [Cobb angle 45-50 degree and showing signs of respiratory or cardio functional impairement; Posterior Spinal fusion with instrumentation]