Scoliosis

Previously  Lateral curvature of the spine

Currently  3 dimensional deformity of the spine

1. Hypokyphosis / Lordosis in saggital plane

2. Tilting in coronal plane
3. Rotation in axial plane

Non-structural scoliosis – reversible lateral curvature of the spine without rotation

Structural scoliosis – irreversible lateral curvature of the spine with rotation of the vertebral bodies

Etiological classification of scoliosis

 Non-structural scoliosis (Reversible)

o Habitual poor posture (Postural Scoliosis)
o Pain and muscle spasm
o Lower limb-length discrepancy
 Structural Scoliosis (Irreversible)
o Idiopathic (85% of case)
o Osteopathic
o Neuropathic
o Myopathic

Idiopathic Scoliosis

 85% of scoliosis
 Primarily a cosmetic problem

Incidence and Etiology

 Infantile type (Birth – 3 Y.O.)

 Juvenile type (4 – 9 Y.O.)
 Adolescent type (10 Y.O. – end of growth)

Pattern of growth:

 Lumbar
 Thoracolumbar
 Thoracic
 Combined lumbar and thoracic (Double major curve)

Most common is Right thoracic in adolescent girls

Pathogenesis and Pathology

 Progression with skeletal growth, particularly rapid during adolescence.

 Persistent malalignment of the spinal joints may become worse very slowly (1⁰/year) even after growth is
over.
 When curve is > 40⁰ it usually leads to painful degenerative joint disease of the spine.

Clinical feature and Diagnosis

 Idiopathic scoliosis begins slowly, insidiously, and painlessly.

 Readily detected clinically at 30⁰
 Rotation of spine most noticeable from behind when patient bends forward

Radiographic examination (AP & Lateral)

 Include full length of spine in standing position

 Curvature always more marked than physical appearance
 MRI if neurological deficit, neck stiffness, or headache is present

Prognosis determined by:

 Amount of growth that remains

 Degree of curvature at the time of assessment

Treatment

Prevent progression of mild scoliosis and to correct and stabilize a more severe deformity

Non-operative:

 TLSO (Thoracolumosacral Orthosis)

 Most commonly used – Boston brace
 Charleston splint

Operative (curvature 40⁰):

 Internal spinal instrumentation

 Spinal fusion