Scoliosis

Question 1

Detection and Clinical Exam

Answer 1

Detected by asymmetries in trunk, shoulder, or pelvis
Little evidence of effectiveness of screening of asymptomatic adolescents

If asymmetries are identified refer to ortho surgeon to obtain baseline measurements and for continue monitoring

Exam includes:

• hx, familial conditions, general health, physical maturity
• s/s of any underlying disease and neuro status
• Physical exam: alignment, forward bend test, LLD, scoliometer (quantifies rib hump magnitude during forward bend test)

Scoliometer reading of 5 or greater warrants referral to ortho and indicates need for x-ray

Question 2

Radiographs

Answer 2

Anterior and lateral views- determine location, type, magnitude of curve, and skeletal age

Skeletal maturity determined by Risser Sign

• quantifies amt of ossification in iliac crest
• Grades 0-5
• – 0 = absence of ossification
• – 1-4 = range for 25-100%
• —- 0-2 = skeletal immaturity
• —- 3 = progressing skeletal maturity
• —- 4 = cessation of spinal growth
• – 5 = fusion of iliac crest with ileum, cessation of growth with increase in height

Additional imaging may be required for dx of additional spinal conditions

Question 3

Cobb Method

Answer 3

Measures spinal curvatures

1. Identify end vertebrae- most cephalad vertebrae of curve whose upper surface maximally tiles toward the curces concavity and the most caudal vertebrae with the maximal tilt toward the convexity
2. Lines drawn as extension of end vertebrae from end plate or pedicles
3. Angle of lines intersecting is degree of curvature

Question 4

Terminology

Answer 4

Scoliosis = lateral curvature of spine, curve in coronal plane must be at least 10d with a vertebral rotation component on x-ray

Magnitude = measured using Cobb method

Direction = determined by CONVEXITY
- 90% of thoracic curves are right, left thoracic curve requires further investigation

Question 5

Two Types of Curves

Answer 5

Structural: cannot be voluntarily, passively, or forcibly fully corrected, rotation of the vertebrae is towards the convexity of the curve, fixed thoracic prominence of rib hump

Non-Structural: fully corrects clinically and on xray on lateral bend toward the apex of the curve, lacks rotational component, usually non-progressive, most commonly caused by a shorter LE on the side of the apex–important to monitor to prevent deformity