Scoliosis
apparent lateral curvature of the spine
postural/structural
Scoliosis
Postural Structural
- Correctable - Fixed
- Secondary/compensatory to - Deformity of the affected
some condition outside the spinal segment -Vertebral
spine rotation
- Eg short leg or pelvic - Forward bending make curve
tilt(contracture of hip) more obvious
Aetiology
• idiopathic
• bone anomalies- congenital or osteopathic
• neuropathic
• myopathic
• connective tissue disorder
Clinical features
deformity
• obvious skew back
• rib hump
• asymmetrical prominence of one hip
Backache
Pain - rare compliant
Spine - obvious deviation or more apparent when pt bends forward
Rib hump
Investigation
Imaging
• full length PA and lateral xrays of spine and iliac crest while the pt is
standing
• Structural scoliosis (in PA view)
• Vertebrae towards apex appeared asymmetrical
• Spinous processes deviated to the concave side
• Cobb’s angle
• Standard measure Angle of curvature
• Upper and lower ends of curve are identified as levels where vertebrae
start to angled away from the curve
• Degree of curvature: upper border of the uppermost vertebrae & lower
border of the lowermost vertebra
• Scoliosis is Cobb angle ≥10°
• CT and MRI- vertebral abnormality or cord compression
• svere chest deformities - lung function test
Treatment
• Aim : prevent severe deformity
• Depends on different types o scoliosis
Idiopathic Scoliosis
- adolescent
- juvenite
- infantile
- early onset
- late onset
Late onset (adolescent) >10yr
Non operative Operative
• approach skeletal maturity and • 1) curves >30degree
deformity acceptable <30degree, • 2) deteriorating rapidly
well balanced - Tx unnecessary
• Exercise
• Bracing ?
Early onset (juvenile) 4-9 yrs
• uncommon
• worse prognosis and surgery may be necessary before puberty
• If very young, brace to hold the curve till age of 10
Infantile <3 yrs
• rare
• 90% resolve spontaneously
• potentially progressive curve - elomgation derotation flexion (EDF)
plaster cast until deformity resolve or big enough for cast
• after 4yr, curve progression slowdown or cease and no further
treatment needed
• Surgical if deteriorate
