(3) Structural Scoliosis Etiologies Flashcards
What are the 2 types of congenital scoliosis?
- osteogenic
- neuropathic
Name 3 congenital bony anomalies which can cause scoliosis.
- hemivertebrae (lateral)
- rib synostosis
- butterfly vertebrae
Name 3 congenital neuropathic causes of scoliosis.
- chiari malformation
- tethered spinal cord
- syringomyelia
What are the radiographic features of congenital scoliosis?
- typically a short segment
- higher degree scoliosis
Name 5 underlying conditions resulting in developmental scoliosis.
- NF1
- achondroplasia
- osteogenesis imperfecta
- Marfans syndrome
- Ehlers-Danlos
What are the radiologic features of developmental scoliosis?
findings of underlying disease
(eg. tall vertebrae, posterior scalloping, etc.)
Name 3 neuropathic diseases resulting in neuromuscular scoliosis.
- cerebral palsy
- polio
- spinocerebellar degeneration
Name 2 myopathic diseases resulting in neuromuscular scoliosis.
- muscular dystrophy
- arthrogryposis
What are the radiographic features of neuromuscular scoliosis?
- 1 long curve from T1-S1
- left thoracic scoliosis
What scoliotic curve is an indication for MRI? What would you need to rule out?
left thoracic scoliosis
R/o neuromuscular disease
What osseous tumors may result in tumor-related scoliosis?
- osteoid osteoma
- osteoblastoma
- GCT
What extraosseous tumors may result in tumor-related scoliosis?
- individual neurofibroma
- astrocytoma
- ependymoma
What are the radiologic features of tumor-related scoliosis?
- Osseous: look for tumor findings (geo. lytic post. elements)
- Extraosseous: post. scalloping, enlarged IVFs
A patient with a scoliosis may have an osteoid osteoma on which side?
concave side
What are the potential causes of traumatic scoliosis?
- compression Fx or burst Fx w/ lateral component (lat. wedging)
- TP Fx’s that develop LOBS
What etiologies must be ruled out before determining a degenerative scoliosis?
- congenital
- developmental
- neuromuscular
- tumor-related
- traumatic
What is meant by degenerative scoliosis?
scoliosis with moderate to severe degenerative changes
What are the 2 possible causes of degenerative scoliosis?
- adolescent idiopathic scoliosis that degenerates (can’t tell w/o previous imaging)
- asymmetric spinal degeneration (eg. repetitive asymmetric movements)
What side of adolescent idiopathic scoliosis would degenerate more?
concave side
(can increase a scoliosis 15+ deg over lifetime)
What etiology of scoliosis is a diagnosis of exclusion?
idiopathic
What demographic is most commonly affected by idiopathic scoliosis?
adolescent (11-18) females
What is the most common classification of idiopathic scoliosis?
adolescent (11-18)
What is the most common pattern of adolescent idiopathic scoliosis?
right thoracic
(can have any pattern, including double majors)
What is the greatest concern of adolescent idiopathic scoliosis?
progression
What degree of scoliosis has high rates of biomechanical pain as well as organic issues (i.e., cardiopulmonary, GI, pregnancy)?
> 50 deg
What is the typical progression of scoliosis under 50 degrees?
10-15 deg during entire lifetime
What is the typical progression of scoliosis over 50 degrees?
1 degree per year for life
Name 4 factors concerning progression of scoliosis.
- pts w/ greater spinal growth velocity
- higher Cobb angle at presentation
- congenital etiology (75% progress)
- juvenile scoliosis (old classification; 70-95% progress)
What factors contribute to greater spinal growth velocity?
lower skeletal maturity at presentation:
- age 9-13
- Risser grade 0, 1
- females: premenarchal status
How do we assess skeletal maturation in thoracolumbar radiographs?
Risser sign (formation of iliac apophysis)
How is Risser sign graded?
0-5
(0 hasn’t shown up yet, 5 ASIS to PSIS)
What is the definition of skeletal maturation in females and males using Risser sign?
- F: mature at grade 4
- M: mature at grade 5
Name 3 methods of assessing skeletal maturity.
- Risser sign
- closure of triradiate cartilage
- Left hand/wrist radiograph (Greulich & Pyle Atlas)
