scoliosis

  • A 14-year-old girl comes to your office because her mother is concerned about scoliosis. The mother had mild scoliosis as an adolescent, but she did not require treatment. The girl is
    previously healthy and participates in sports at school. She denies back pain, weakness, or abnormal sensations. On physical examination, lumbar asymmetry is apparent when she bends forward with her arms hanging down. There are no cutaneous findings, and her neurologic examination results are normal. You order posteroanterior and lateral radiographs of the spine to evaluate the degree of scoliosis.
  • Of the following, the radiographic finding that is MOST suggestive of a nonidiopathic cause for
    this girl’s scoliosis is a
    A. Cobb angle of 30 degrees
    B. lack of thoracic kyphosis
    C. lumbar curve to the left
    D. thoracic curve to the right
    E. widening of the pedicles
  • One of the primary considerations for the clinician evaluating an adolescent who has scoliosis is determining whether the scoliosis is idiopathic or due to another abnormality, such as
    vertebral anomaly, leg length discrepancy, spinal cord lesion, or neuromuscular disorder.
  • Scoliosis is defined as a lateral curvature of the spine greater than 10 degrees on a posterioranterior spine radiograph, and most cases in adolescent patients are idiopathic. Clinical features suggesting a secondary cause for the curvature include nighttime or severe back pain and neurologic symptoms, such as bowel/bladder incontinence and weakness.
  • Radiologic findings can add to the suspicion for a secondary cause. In idiopathic scoliosis, the curve is usually to the left in the lumbar region and to the right in the thoracic region (Remember Left-Lumbar). A curve to the opposite side in either of these areas is suggestive of a nonidiopathic cause. Other radiologic features suggesting secondary scoliosis are significant thoracic kyphosis and widening of the pedicles, which can be seen with spinal canal anomalies. The degree of curvature does not distinguish between primary and secondary causes.
  • When a patient seeks medical attention for concerns about scoliosis, it is important to take a complete history, including pubertal development, and perform a complete physical examination, including forward bending test, neurologic evaluation, and skin examination
  • statement endorsed by the American Academy of Pediatrics and orthopedic societies, such as the American Academy of Orthopaedic Surgeons, states that benefits of early bracing could be substantial in some patients and that if screening programs were put in place, screening should be performed in girls at ages 10 and 12 years and in boys at ages 13 and 14 years.

About Dr. Jayaprakash

Asst. Prof. of Pediatrics, ICH. Institute of Child Health. Gov. Medical College Kottayam. Kerala, India.

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