(3) Scoliosis Intro Flashcards
What is a scoliosis?
lateral curvature of the spine of 10 degrees or greater
What landmarks are used when assessing scoliosis?
- end vertebrae (last vertebrae that contribute to equal or greater curve)
- apical vertebra (most lateral vertebra)
In a scoliosis, a secondary curve is also called a ____ curve
compensatory
What is a major curve in a scoliosis?
the larger(est) curve(s), usually in a structural scoliosis
What is a minor curve in a scoliosis?
the smaller(est) curve(s)
What is a primary curve in a scoliosis?
the first or earliest of several curves to appear, if idientifiable
What is a secondary curve in a scoliosis?
a curve above or below the primary curve, functioning as an adaptation to the primary curve and maintaining normal body alignment
(may be structural)
What is a double major scoliosis?
a scoliosis with 2 structural curves occurring in different spinal areas
What is a double primary scoliosis?
a scoliosis with 2 curves occurring in 1 spinal area
What side is a scoliosis named for?
convexity
What methods may be used for clinical evaluation of scoliosis?
- screening of adolescents
- standing postural evaluation
- Adam test
- side bending
- imaging
What orthopedic test is used to assess structural versus functional scoliosis?
Adam test
What is the standard method of determining structural versus functional scoliosis?
imaging
(radiographs preferred, MRI/CT follow-up if needed)
What is the concern for imaging of adolescent idiopathic scoliosis (AIS)?
- average 22 torso radiographs
- 110% increase in breast cancer over general population
What is the purpose of initial radiography of scoliosis?
- confirm presence of scoliosis
- quantify scoliosis
- determine possible etiologies
What radiographic view is used for initial imaging of scoliosis?
AP
(must be weight bearing)
What radiographic view is used for follow-up imaging of scoliosis?
PA
(must be weight bearing)
What state of the art imaging modality is used for follow-up imaging of scoliosis?
EOS imaging
(high quality, low dose; changes radiation level at each segment)
What is the gold standard measurement for quantifying scoliosis?
Cobb angle
(angle between end vertebrae)
What method is used to assess rotation of scoliosis?
Nash Moe method (using pedicles)
What radiographic view should never be used for scoliosis (or ever)?
lateral full spine
What are the possible structural etiologies of scoliosis?
*must R/o in this order:
- congenital
- developmental
- neuromuscular
- tumor-related
- degenerative
- idiopathic
What are the possible functional etiologies of scoliosis?
- spasm/antalgia
- muscle imbalance
- leg length inequality
What is the Hueter-Volkmann principle?
in developing vertebrae:
- portions under compressive load slow growth (concave)
- portions under tensile load accelerate growth (convex)
Resulting in structural wedging of vertebrae
When describing a scoliosis, what information must be included?
side, region, “scoliosis”
What radiographic organ shadows occur on the right side of the body?
liver
What radiographic organ shadows occur on the left side of the body?
- heart
- meganblasse (stomach gas)
What is meant by functional scoliosis?
curves that have a mechanical cause, which are flexible with lateral bending
What is the threshold of significance for anatomical leg length inequalities (LLI) generating MSK pain?
10mm
What screening tool can be used for anatomical leg length inequalities (LLI)?
AP lumbars including the femoral heads
If there is concern for an LLI, what follow-up imaging should be ordered?
scanogram
(measures each segment of leg to determine cause)
What is the only type of scoliosis with recommended follow-up imaging?
adolescent idiopathic scoliosis
What is the recommended time frame for follow-up imaging of adolescent idiopathic scoliosis?
- if Risser grade 0-1, then 4-6 months
- if clinical findings of progression, image sooner
- if higher maturation (grade 2-3), 6-12 months
- no further imaging once skel. mature, except over 30 degrees, then every 5 yrs
What is the management for scoliosis under 20 degrees?
- monitor
- repeat radiographs every 4-12 months depending on skel. maturation
What is the management for scoliosis of 20-40 degrees?
Bracing (Boston or Milwaukee)
What degree of scoliosis may be managed with bracing?
- 20-40 deg
- if 0-20 deg curve progresses 5 deg or greater during an interval
What is the purpose of scoliosis bracing?
to prevent progression
(does not correct curvature)
What is the management for scoliosis of 40 degrees or greater?
surgical correction & fusion (pedicle screws & contour rods)
What degree of scoliosis may be management with surgical correction?
- 40+ deg
- if 20-40 deg curve progresses 5 deg or greater during an interval
