Scoliosis Flashcards
Definition of idiopathic adolescent scoliosis
Idiopathic scoliosis in kids 10-18 years old
Most common curve seen in idiopathic adolescent scoliosis?
Right thoracic. Left thoracic curves are rare and require MRI to rule out cyst or syrinx
Curvature associated with cardiopulmonary dysfunction and early death?
90 degrees
Risk factors for curve progression
> 25 degrees before skeletal maturity
50 thoracic or > 40 lumbar curve after skeletal maturity progresses at 1-2 degrees per year
lumbar
Double > single
Best predictor of curve progression
Peak growth velocity, if curve is > 30 degrees before this time they need surgery
When do girls typically reach skeletal maturity?
1.5 years after puberty
Classification systems
King-Moe and Lenke
Tool used in school screening exams
7 degree threshold on scoliometer
Physical exam
Adams forward bending, have patient sit if concerned limb length is causing curve.
Leg length, skin defects, shoulder height, truncal shift, rib prominence, pelvic tilt, cafe-au-lait spots, pes cavovarus, Hoffman, Babinski, clonus, sacral dimple/hair,
Radiographs
Cobb angle > 10 degrees in positive
Stable zone: vertical lines from lumbosacral facets
Stable vertebrae: most proximal vertebrae aligned centrally with central sacral vertical line
Neural vertebrae: spinous processes equidistant from pedicles on PA (not rotated)
Apical vertebrae: vertebra farther from center
Determining spine balance on plain radiographs in the coronal and sagittal planes
Coronal: C7 plumb to central sacral vertical line
Sagittal: C7 plumb to posterior and superior corner of S1
Indications for MRI
Atypical curve (left thoracic, short angular and atypical/excessive kyphosis) Rapid progression Neurologic symptoms Foot deformity Abnormal abdominal reflexes (T5-T12)
Indications for observation alone
Cobb angle
Indications for bracing (stops progression, doesn’t reverse)
Cobb angle 25-45 Skeletally immature (Risser 0, 1, 2)
Patients with poor prognosis w/bracing
Poor correction w/brace
Hypokyphosis
Obese, male, non-compliant
Indications for posterior spinal fusion
Cobb angle > 45
Gold standard for thoracic & double major curves
Indications for anterior spinal fusion
Thoracolumbar and lumbar deformity with normal sagittal profile
Indications for anterior-posterior fusion
Curves > 75 degrees
Stiff curves
Risser grade 0, boys
Minimum requirement to wear brace to slow scoliosis progression
12 hrs/day
Definition of bracing failure
> 6 degrees or more of progression
Progression to > 45 degrees
Definition of skeletal maturity
Risser 4
If possible, always avoid fusion of what levels in posterior fusions for scoliosis?
L4-L5, increased incidence of back pain with L5 fusions
How to avoid crankshaft phenomenon
Perform anterior discectomy and fusion in patients that are very young and are undergoing posterior spinal fusion
Scoliosis surgery complications
Nerve injury, crankshaft phenomenon, SMA syndrome, infection, flat back syndrome and hardware failure.
Definition of juvenile idiopathic scoliosis
Onset between ages 4-10
Conditions associated with juvenile idiopathic scoliosis
Syringomyelia Arnold-Chiari malformation Tethered cord Dysraphisms Spinal cord tumors Bowel/bladder dysgenesis
Infantile idiopathic scoliosis
Scoliosis in children less than 3
Infantile idiopathic scoliosis unusual epidemiological factors
Boys > girls, left curve > right curve, most resolve spontaneously
What spinal segment grows most rapidly in the 1st 5 years of life?
T1-L5
Rib vertebral angle difference (RVAD)
Measure between endplate and rib (line between midpoint of rib head and neck). Then take the difference from another angle. > 20 degrees = high rate of progression.
How does neuromuscular scoliosis differ from idiopathic?
Progresses more rapidly, even after maturity
Associated with pelvic obliquity
Involve more vertebra
High rate of pulmonary complications with surgery
Neuromuscular diseases associated with scoliosis
CP, Rett syndrome, SMA, muscular dystrophy, spina bifida and polio
Schuermann’s kyphosis
Rigid thoracic hyperkyphosis > 45 degrees due to anterior wedging > 5 degrees across 3 or more vertebra
Schmorl’s node
Disc herniation into vertebral body. Seen in Schuermann’s kyphosis.
