Structural Scoliosis

Question 1

Which conditions mimic idiopathic scoliosis?

Answer 1

NF and syringomyelia

Question 2

What are common causes of structural scoliosis?

Answer 2

Neurologic
Congenital
Connective tissue diseases
Idiopathic

Question 3

What are reversible neurologic causes of structural scoliosis?

Answer 3

Chiari malformations
NF
Tethered spinal cord

Question 4

What are irreversible neurologic causes of structural scoliosis?

Answer 4

Cerebral palsy

Muscular dystrophy

Question 5

What are Chiari malformations?

Answer 5

Congenital deformities of the brain stem and upper spinal cord e.g. syringomyelia

Question 6

How would you correct scoliosis induced by Chiari malformations?

Answer 6

Surgical decompression of the malformation

Question 7

What imaging must be performed for all new structural scoliosis patients?

Answer 7

Craniocervical junction MRI

Question 8

What is NF?

Answer 8

Benign tumors which may impinge on the spinal cord or nerve roots. Removal of these tumors results in correction of the scoliosis.

Question 9

What is the treatment of choice for scoliosis caused by irreversible neurologic factors?

Answer 9

Surgical fusion of the spine

Question 10

Which connective tissue diseases can cause structural scoliosis?

Answer 10

Marfan syndrome

Ehlers-Danlos syndrome

Question 11

What is the most likely origin of idiopathic scoliosis?

Answer 11

Genetic in origin – it has a polygenic expression. First degree relatives have a 10% prevalence of scoliosis.

Question 12

How do you distinguish between a double major curve and a simple C-shaped curve with a compensatory curve?

Answer 12

The compensatory curve will reverse with sidebending. The primary curve will not.

Question 13

How can OMT treat scoliosis?

Answer 13

Removes coexisting somatic dysfunction
May halt the progression of mild curves
Helps maintain mobility of spine and rib cage
Improves respiratory and cardiac function in patients with severe curves

Question 14

How does exercise prevent progression of scoliosis?

Answer 14

It doesn’t. There is no evidence that exercise changes the course of idiopathic scoliosis. It does aid in maintaining mobility of the spine. The better the mobility, the better the outcome of bracing or surgery.

Question 15

How do braces aid in treatment of scoliosis?

Answer 15

Braces do not correct scoliosis. They are successful at halting the progression of a significant number of curves.

Question 16

What is the most common brace?

Answer 16

Milwaukee brace

Question 17

How do you determine the end of bone growth?

Answer 17

Risser scale

Judges end of bone growth by the fusion of the iliac crest with the ilium.

Question 18

At what age does skeletal maturity occur?

Answer 18

16 in females

18 in males

Question 19

Which treatment can avoid flat back syndrome?

Answer 19

Pedicle screws and contoured rod. Allows for preservation of sagittal plane curves.

Question 20

What are the three types of scoliotic curves?

Answer 20

Idiopathic
Congenital
Paralytic

Question 21

How do you determine the severity of the curve?

Answer 21

Cobb angle
Level of apex
Degree of rotation

Question 22

Curves greater than ___ degrees are at increased risk for shortness of breath.

Answer 22

50

Question 23

What is Wolff’s law?

Answer 23

Distortion of the pelvis caused by a structural scoliosis.

Bone is laid down along lines of stress.

Question 24

When is surgery recommended for thoracic curves?

Answer 24

55 degrees

Question 25

When is surgery recommended for lumbar curves?

Answer 25

45 degrees

Question 26

When is surgery recommended for thoracolumbar curves?

Answer 26

40 degrees

Question 27

When is surgery recommended for double major curves?

Answer 27

Almost 60 degrees

Question 28

What is the main difference between idiopathic and paralytic curves?

Answer 28

Idiopathic curves are RIGID. Paralytic curves are mobile, but not sustainable–must have traction.

Question 29

When are OMT, traction, and exercise the sole source of treatment?

Answer 29

Only for mild curves (<20 degrees)