Scoliosis

Question 1

Definition

Answer 1

3D deformity of the spine and trunk, appears in apparently health children, progresses in relation to multiple factors

• rotation
• lateral translation
• collapse

Question 2

Types of Scoliosis

Answer 2

Non-Idiopathic - know the cause
- CP, neuromuscular disease

Idiopathic - don’t know the cause or what is driving the deformity
- majority

Question 3

Structural Deformity - Frontal Plane

Answer 3

one side of vertebral body collapses towards the concavity
becomes wedge shaped
no growth on the collapsed side, other side has increased growth rate due to increased space
results in increased growth into the lateral curve

Question 4

Structural Deformity - Sagittal Plane

Answer 4

First sign of scoliosis
Relative anterior spinal growth - vertebral body becomes wedged in AP direction
lose sagittal curves- flatback
shoulder blades appear to be retracted

Question 5

Structural Deformity - Torsional

Answer 5

growth induced rotation from other deformities
wedging blocks flexion and extension
when flex - rotate into the direction of scoliosis

Question 6

Plane of Maximal and Minimal Deformity

Answer 6

Maximal - least rectolinear
Minimal - most rectolinear

For scoliosis - max in frontal, min in sagittal

Question 7

Classification of Severity

Answer 7

Mild 10-29 degrees
Moderate 30 - <49 degrees
Severe 50+

when at 30 - large change will continue to progress, key time to intervene surgically

once reach 50 - almost 100% likelihood will increase further and have other complications

Question 8

Naming

Answer 8

idiopathic vs non-idiopathic (state cause)
adolescent - >10yo
juvenile - 3-10yo
infantile - <3yo 
adult degenerative 
curve size and direction 
curve location 

direction - name to the convex side, not the collapsed side

Question 9

Aims of Treatment

Answer 9

stop progression - open up growth plate, prevent compression on the collapsed side 
improve aesthetics 
promote good upright posture 
improve general health 
learn to cope with deformity 
reduce functional limitations

Question 10

Clinically Important Questions

Answer 10

child or adult?
how much growth do they have left?
can we change their structure or do we have to work with their curve?
watch for complications/progression 
child - do need to refer on?
sagittal curve severity 
joint hypermobility 
anxiety

Question 11

Red Flags

Answer 11

left thoracic scoliosis
leg length discrepancy
high thoracic and cervical curves
pain

Question 12

Treatment - Child

Answer 12

If <20 degrees

• PSSE main
• focus is stability
• pain relief without destabilisation
• general strengthening and overall fitness

If 20-70 degrees

• bracing
• PSSE
• avoid flexion, side flexion, rotation
• must have orthopaedic surgeon and specialist team
• general strengthening and fitness

If 70 degrees +

• early intervention surgery
• no bracing

Question 13

Treatment - Adult

Answer 13

Main focus = stability

Mild Curve - PSSE

• monitor for complications
• general strength
• pain relief
• focus on stability

Mod Curve - PSSE

• consider specialist team
• consider if need to involve scoliosis physio
• pain relief - without destabilising
• no flexion, side flexion, rotation
• general strength and fitness

Severe Curve -

• surgery
• involve specialist team and physio
• no passive pain relief
• no F, SF, Rot
• spinal fusion