Scoliosis

Idiopathic scoliosis often does not progress enough to require treatment and observation is sufficient. Painful scoliosis is a serious complaint, as an underlying condition may be the nidus of the curvature. Surgery is performed to fuse progressive curves greater than 50°, but surgical complications may occur, such as postoperative neurologic deficit.

Differential Diagnosis

• Idiopathic scoliosis
  –Lateral deviation or curvature of either the thoracic or lumbar spine greater than 10°
  –Right thoracic curves are most common
  –Usually presents in early adolescence
  –Girls > boys
• Risk factors for progression
  –Curve >20°
  –Age less than 12
  –Skeletal maturity, Risser stage 0–1
• Infantile idiopathic scoliosis
  –Presents at 0–3 years old
  –Left thoracic curve more common
  –Boys > girls
  –85% spontaneously resolve
  –Must rule out spinal cord disease or congenital cause of scoliosis
• Juvenile idiopathic scoliosis presents at 3–10 years old and is similar to adolescent (idiopathic) scoliosis

• Neuromuscular scoliosis
  –Related to cerebral palsy, muscular dystrophy, myotonic myopathy, and spinal muscular atrophy
  –Tends to progress more rapidly and even continues after maturity, as compared to idiopathic scoliosis
  –Pulmonary complications seen with severe curves >90°

• Congenital scoliosis
  –Failure of formation or segmentation of spinal vertebra
  –Rapid progression and worse prognosis is associated with unilateral unsegmented bar with contralateral hemivertebra
• Other causes
  –Tumor, infection, neurofibromatosis, metabolic bone disorders, and Marfan syndrome

Workup and Diagnosis

• Generally patients are referred after either school screening for scoliosis or well-child check
• History
  –Painful symptoms in the history should be a red flag to rule out infection, tumor, or spinal cord anomaly
  –There is often a positive family history
  • Clinical examination
    –Careful neurologic examination
    –Moderate to severe curves demonstrate shoulder and waist asymmetry, trunk shift, and limb length inequality
    –Forward bending test: Examiner stands behind patient while patient bends forward from the waist, hands hanging down, feet together and knees straight, evaluating for rib hump or depression or asymmetric paravertebral muscles
    –Scoliometer may be used to measure rotational deformity (>7° requires radiographic evaluation)
  • Radiographic studies
    –X-ray: Standing AP and lateral radiographs allow measurement of curves by Cobb method (Cobb angle is made by line drawn along superior endplate of uppermost tilted vertebra and a line drawn along inferior endplate of lowest vertebra in curve)
    –MRI indicated for neurologic compromise, excessive kyphosis, onset of scoliosis after age 11 years, rapid curve progression, structural abnormalities noted on plain X-ray, and left thoracic or thoracolumbar curves

  Treatment

  • Treatment options include observation while child is growing, bracing, and surgery
    –Many curves do not progress enough to require treatment
    –Spinal curve progression may occur despite bracing; however, for idiopathic scoliosis, response to brace wearing is dose-related and many patients do not like to wear the brace
  • Exercise and electrical stimulation have not been shown to alter natural progression of curve
  • Bracing for curves in 20–40° degree range may slow curve progression but does not reduce the magnitude of curve despite a well-made brace and compliance
  • Surgery is reserved for progressive curves >40° in skeletally immature (Risser scale 0–1) and >50° in skeletally mature patients

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Posture symptoms

Read excerpts from these other book chapters related to Posture symptoms:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Posture symptoms

• Back to symptom: Posture symptoms: Introduction (review 91 causes)
• Next Book Extract About Posture symptoms: Decorticate posture (Handbook of Signs & Symptoms (Third Edition))
• All Book Extracts: All Online Book Extracts for Posture symptoms

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Decorticate posture (Handbook of Signs & Symptoms (Third Edition))
• Decerebrate posture (Handbook of Signs & Symptoms (Third Edition))
• Orthostatic hypotension [Postural hypotension] (Handbook of Signs & Symptoms (Third Edition))
• Scoliosis (Professional Guide to Diseases (Eighth Edition))
• Decerebrate posture [Decerebrate rigidity, abnormal extensor reflex] (Professional Guide to Signs & Symptoms (Fifth Edition))

Tools & Services:

• Bookmark this page
• Take a survey relating to Posture symptoms
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com