MSK

Question 1

Define adolescent idiopathic scoliosis

Answer 1

Abnormal lateral curvature of spine in coronal plane

- curve > 10

Question 2

Causes of AIS

Answer 2

Structural
- idiopathic
- congenital
- neuromuscular
   - neuropathic - cerebral palsy, spina bifida, tumour
   - myopathic - muscular dystrophy
- Marfan disease
- Ehlers-Danlos disease
- traumatic
Non-structural
- postural - prolonged poor posture, scoliosis resolves when child lies supine
- compensatory - spine is straight but appears curved due to pelvic obliquity

Question 3

Clinical features of AIS

Answer 3

Major and minor compensatory curve in spine
Vertebral bodies rotate - spinous process deviated to concave side
Adam’s forward bend test - curvature and hump on convex side
Scoliometer
Full neuro exam required
Should be painless

Question 4

Mx of AIS

Answer 4

Cobb angle < 25
- observation and serial radiographs
CA 25-45
- bracing until skeletal maturity reached - reduce further curvature
CA > 45
- spinal fusion

Question 5

Define Scheuermann disease

Answer 5

Excessive thoracic kyphosis > 45 due to defect in secondary ossification within vertebrae
- wedge-shaped vertebral bodies

Question 6

Clinical features of Scheuermann disease

Answer 6

Pain
Risk of disc prolapse
Cosmesis concern

Question 7

Mx of Scheuermann disease

Answer 7

< 60
- observation and physiotherapy
60-80
- bracing
80+
- surgery - or if severe pain/neurological deficit