Scoliosis

Question 1

Definition of idiopathic adolescent scoliosis

Answer 1

Idiopathic scoliosis in kids 10-18 years old

Question 2

Most common curve seen in idiopathic adolescent scoliosis?

Answer 2

Right thoracic. Left thoracic curves are rare and require MRI to rule out cyst or syrinx

Question 3

Curvature associated with cardiopulmonary dysfunction and early death?

Answer 3

90 degrees

Question 4

Risk factors for curve progression

Answer 4

> 25 degrees before skeletal maturity
50 thoracic or > 40 lumbar curve after skeletal maturity progresses at 1-2 degrees per year
lumbar
Double > single

Question 5

Best predictor of curve progression

Answer 5

Peak growth velocity, if curve is > 30 degrees before this time they need surgery

Question 6

When do girls typically reach skeletal maturity?

Answer 6

1.5 years after puberty

Question 7

Classification systems

Answer 7

King-Moe and Lenke

Question 8

Tool used in school screening exams

Answer 8

7 degree threshold on scoliometer

Question 9

Physical exam

Answer 9

Adams forward bending, have patient sit if concerned limb length is causing curve.
Leg length, skin defects, shoulder height, truncal shift, rib prominence, pelvic tilt, cafe-au-lait spots, pes cavovarus, Hoffman, Babinski, clonus, sacral dimple/hair,

Question 10

Radiographs

Answer 10

Cobb angle > 10 degrees in positive
Stable zone: vertical lines from lumbosacral facets
Stable vertebrae: most proximal vertebrae aligned centrally with central sacral vertical line
Neural vertebrae: spinous processes equidistant from pedicles on PA (not rotated)
Apical vertebrae: vertebra farther from center

Question 11

Determining spine balance on plain radiographs in the coronal and sagittal planes

Answer 11

Coronal: C7 plumb to central sacral vertical line
Sagittal: C7 plumb to posterior and superior corner of S1

Question 12

Indications for MRI

Answer 12

Atypical curve (left thoracic, short angular and atypical/excessive kyphosis)
Rapid progression
Neurologic symptoms
Foot deformity
Abnormal abdominal reflexes (T5-T12)

Question 13

Indications for observation alone

Answer 13

Cobb angle

Question 14

Indications for bracing (stops progression, doesn’t reverse)

Answer 14

Cobb angle 25-45
Skeletally immature (Risser 0, 1, 2)

Question 15

Patients with poor prognosis w/bracing

Answer 15

Poor correction w/brace
Hypokyphosis
Obese, male, non-compliant

Question 16

Indications for posterior spinal fusion

Answer 16

Cobb angle > 45

Gold standard for thoracic & double major curves

Question 17

Indications for anterior spinal fusion

Answer 17

Thoracolumbar and lumbar deformity with normal sagittal profile

Question 18

Indications for anterior-posterior fusion

Answer 18

Curves > 75 degrees
Stiff curves
Risser grade 0, boys

Question 19

Minimum requirement to wear brace to slow scoliosis progression

Answer 19

12 hrs/day

Question 20

Definition of bracing failure

Answer 20

> 6 degrees or more of progression

Progression to > 45 degrees

Question 21

Definition of skeletal maturity

Answer 21

Risser 4

Question 22

If possible, always avoid fusion of what levels in posterior fusions for scoliosis?

Answer 22

L4-L5, increased incidence of back pain with L5 fusions

Question 23

How to avoid crankshaft phenomenon

Answer 23

Perform anterior discectomy and fusion in patients that are very young and are undergoing posterior spinal fusion

Question 24

Scoliosis surgery complications

Answer 24

Nerve injury, crankshaft phenomenon, SMA syndrome, infection, flat back syndrome and hardware failure.

Question 25

Definition of juvenile idiopathic scoliosis

Answer 25

Onset between ages 4-10

Question 26

Conditions associated with juvenile idiopathic scoliosis

Answer 26

``` Syringomyelia Arnold-Chiari malformation Tethered cord Dysraphisms Spinal cord tumors Bowel/bladder dysgenesis ```

Question 27

Infantile idiopathic scoliosis

Answer 27

Scoliosis in children less than 3

Question 28

Infantile idiopathic scoliosis unusual epidemiological factors

Answer 28

Boys > girls, left curve > right curve, most resolve spontaneously

Question 29

What spinal segment grows most rapidly in the 1st 5 years of life?

Answer 29

T1-L5

Question 30

Rib vertebral angle difference (RVAD)

Answer 30

Measure between endplate and rib (line between midpoint of rib head and neck). Then take the difference from another angle. > 20 degrees = high rate of progression.

Question 31

How does neuromuscular scoliosis differ from idiopathic?

Answer 31

Progresses more rapidly, even after maturity Associated with pelvic obliquity Involve more vertebra High rate of pulmonary complications with surgery

Question 32

Neuromuscular diseases associated with scoliosis

Answer 32

CP, Rett syndrome, SMA, muscular dystrophy, spina bifida and polio

Question 33

Schuermann's kyphosis

Answer 33

Rigid thoracic hyperkyphosis > 45 degrees due to anterior wedging > 5 degrees across 3 or more vertebra

Question 34

Schmorl's node

Answer 34

Disc herniation into vertebral body. Seen in Schuermann's kyphosis.