Idiopathic Scoliosis Flashcards
Scoliosis is defined as lateral curvature of the spine in the coronal plane (frontal plane) with Cobb angle greater than 10 degrees. Which of the following is the type of idiopathic scoliosis which occurs at the age of 10 to 17 years and with overwhelming female predominance?
● A. Congenital scoliosis
● B. Infantile scoliosis
● C. Juvenile scoliosis
● D. Adolescent idiopathic scoliosis
● E. None of the above
D. Adolescent idiopathic scoliosis
Patients with idiopathic scoliosis are more commonly females and mostly have dextroscoliosis (convex to right side). Imaging for these patients consist of lateral and neutral PA coronal X-rays and left-bending plus right-bending coronal X-rays are done only if surgery is planned. Which of the following statements is incorrect regarding treatment of these patients?
● A. Treatment is based on skeletal maturity and magnitude of scoliosis
● B. Growing patients with curves less than 25 degrees or skeletally mature patients with curves less than 45 to 50 degrees are managed with observation only
● C. Bracing prevents progression but does not correct scoliosis and bracing makes no sense in skeletally mature patients
● D. Use of bracing in patients with curves 25 to 40 degrees who are still growing or in skeletally immature patients with curves more than 45 degrees is done to tide them over until they can have surgery
● E. For growing patients with early scoliosis, there is no need of fixation or vertebral body tethering
E. For growing patients with early scoliosis, there is no need of fixation or vertebral body tethering
“Reduced growth in areas of compressed cartilage (physes) in the curve concavity may result in progression of scoliosis through development of vertebral body wedging from asymmetric growth”; this principle for adult idiopathic scoliosis is known as what?
● A. Heuber principle
● B. Hueter-Volkmann principle
● C. Heishemer-Volkmann principle
● D. Spence principle
● E. None of the above
B. Hueter-Volkmann principle
Which of the following physical findings can be found in scoliotic patients?
● A. Shoulder asymmetry, pelvic tilt, age length discrepancy, breast asymmetry, and trunk shift (shift of thorax to one side as compared to the pelvis)
● B. Adams forward bend test which is done by putting the feet of the patient together and forward bending with the knees straight and arms dangling which will result in a rib hump on the convex side of thoracic scoliotic curve
● C. Neurologic examination to look for abdominal cutaneous reflex, deep tendon reflexes, strength, and sensations
● D. Evidence of underlying conditions like arachnodactyly, skin pigment changes, tufts of hair, or dimpling over the spine
● E. All of the above
E. All of the above
Riser staging for assessing skeletal maturity in adolescent patient to guide decisions for bracing and timing of surgery includes following except?
● A. Stage 0 is no ossification center in the iliac crest apophysis
● B. Stages 1, 2, and 3 consist of apophysis of iliac crest up to less than 25%, 25 to 50%, and 50 to 75%, respectively
● C. Stage 4 consists of more than 75% of apophysis of the iliac crest, while stage 5 consists of complete ossification and fusion of the iliac crest apophysis
● D. Grades 0 and 1 are growing rapidly, and scoliosis curve acceleration begins in stage 0
● E. Grades 4 and 5 are growing rapidly
E. Grades 4 and 5 are growing rapidly
Which of the following are strong indications of MRI in scoliotic patients?
● A. Early-onset scoliosis in age less than 10 years
● B. Adolescent idiopathic scoliosis in males
● C. Atypical curves like thoracic levoscoliosis, kyphosis
● D. Hyperkyphosis
● E. Neurologic deficit
● F. All of the above
F. All of the above
Major curve in a scoliotic patient is the largest curve and there can be only one major curve which is almost always present at MT (main thoracic from T6 to T11, T12 disk) or TL/L (thoracolumbar/lumbar). There are other two minor curves besides the major curve, which can be structural or nonstructural. Which of the following is a structural criterion of minor curve?
● A. Side-bending residual Cobb angle more than or equal to 25 degrees
● B. A and/or T2–T5 kyphosis more than or equal to plus 20 degrees
● C. A and/or T10–L2 kyphosis more than or equal to plus 20 degrees
● D. All of the above
D. All of the above
Lenke classification is the de facto standard for classifying AIS. Following are true regarding this classification except?
● A. Type one is main thoracic
● B. Type two is double thoracic
● C. Type three is double major
● D. Type four is triple major
● E. Type five is thoracolumbar/lumbar
● F. Type six is thoracolumbar/lumbar minor thoracic
F. Type six is thoracolumbar/lumbar minor thoracic
Two basic types of braces are TLSO with a goal to wear for 18 to 23 h/d and night time TLSO with a goal to wear for 10 hours per night. Which of the following are contraindications of bracings?
● A. In skeletally mature patients
● B. Thoracic lordosis
● C. Insensate patients or insufficient neuromuscular function
● D. ± significant obesity
● E. Sanders scale 2 to 5 with curves more than or equal to 30 degrees
● F. All of the above
F. All of the above
Which of the following are the surgical fusion goals for a scoliotic patient?
● A. Correct scoliosis as much as possible
● B. Restore thoracic kyphosis
● C. Fuse all structural curves
● D. All of the above
D. All of the above
Which of the following is usually correct for adolescent idiopathic scoliosis (AIS)?
● A. Presents at 4 to 9 years of age
● B. Overwhelming male dominance
● C. Almost all with dextroscoliosis
● D. Majority are lumbar
● E. Potentially curable with Mehta serial casting
C. Almost all with dextroscoliosis
Risser system grades ossification and fusion of the iliac crest apophyses. Ossification of 25 to 50% of the iliac crest apophysis is graded as what stage?
● A. 1
● B. 2
● C. 3
● D. 4
● E. 5
B. 2
In treatment of AIS, observation is appropriate for which curves?
● A. < 25 degrees
● B. > 25 degrees
● C. < 20 degrees
● D. > 20 degrees
● E. < 30 degrees
A. < 25 degrees
Bracing is indicated in AIS for which patients?
● A. Skeletally mature
● B. Insensate patients
● C. Sander stage 1
● D. Sanders stage 3
● E. Thoracic lordosis
C. Sander stage 1
How is AdIS different from AIS?
● A. AIS presents with back and LE pain
● B. Coronal and sagittal malalignments are more common in AdIS
● C. Curves are more flexible in AdIS
● D. Sacrum needs to be included in surgical fusion in AIS
● E. In AIS, a degenerative lumbosacral fractional curve is often present as a result of degeneration
B. Coronal and sagittal malalignments are more common in AdIS
