This is a draft cheat sheet. It is a work in progress and is not finished yet.
Classfiications
Congenital: VB malformation at birth |
Secondary: Another disorder (spinal muscular dystrophy) |
Idiopathic: Cause not known - multiple factors - sometimes genetic (children born to older mothers) |
Subclassfications:
0-5 years of age: Congenital
6-12 years of age: Early onset scoliosis
13-18 years of age: Adolescent idiopathic scoliosis |
Congenital: Includes infantile idiopathic scoliosis - develops within first 2 years - more common in boys - left tx curve, 75% resolve |
Early onset: Mimics adolescent version - more common in females - right tx curve high degree of progression - Neural axis abnormalities (Chiari) |
Adolescent idiopathic: Most common - insidious - chance of progression increases in relation to the curve (large) and decreases in proportion to skeletal maturity (skeletal mature patients) and double/multiple curves |
Risse's sign
Above X-ray showing someone that still is not skeletally mature <14-17 years old in women and <18-22 in men
Cobb's Angle
Progression factor = (Cobb angle - (3x Risser sign)/Patient's age)
Presentation
- Parents notice deformity of their child and get worried - child often has problems with their bodily image |
- Only few present with back pain (some have underlying causes) |
- Triples chance of back pain in adulthood |
- High angle Tx curves (>50o) may impair respiratory function and curves >90o can lead to cardiorespiratory failure |
- Make note of curvature, angle of curve, rib humps, scapula protrusion (right tx most common-right shoulder higher and rotated anterior with right scapula winging) |
- Ask about clue in skeletal maturity and family links |
- Palpate - hamstrings, psoas,paraspinals |
Adam's forward bending: differentiates structural from functional, Structural the rib hump stays, functional it disappears when flexing forward |
- LL discrepency |
- Neuro of LL and UL |
- Vitamin D deficiency can cause scoliosis (screen) |
Imaging
Criteria:
Cobb angle >10o and axial rotation of vertebral bodies
Radiographs should be performed yearly in Rissers stage 0-3 and every 18 months in stage 4-5. (P-A views to reduce leukemia, GI, lung and breast cancers)
Early onset should be monitored every six months
MRI to check for chiari and neural axis
Management
- Stop curve progression |
- Manipulation and myofascial release, bracing |
- EMT of SI joints |
- Core stability exercises and SEAS |
- Bracing (curves between 30 and 40 o in patients who are still growing |
- <0.3% of all scoliosis cases require surgical correction |
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