Definition
Lateral curvature of the spine with coronal plane deformity > 10°
Types
1. Structual
Passively non-correctible deformity of a spinal segment
- vertebral rotation at the apex
2. Nonstructural (CHIPS)
Secondary or compensatory scoliosis
- no rotational component
- fully passively correctable to the midline
Compensatory
Hysterical
Irritative
Postural
Sciatic
Compensatory
- leg length discrepancy
- hip flexion contracture
Hysterical
- teenage females
- no rotation or wedging on XR
Irritative
- painful condition of spine
- fracture, tumour, infection
Postural
- childhood
- slight correctable curve
- disappears on recumbency
Sciatic
- irritation of nerve root by HNP or tumour
- secondary to paravertebral muscle spasm
Structural
Idiopathic 75%
Commences before skeletal maturity
- diagnosis of exclusion
No features to categorise it as
- Congenital
- Neuromuscular
- Other
Types
- Infantile < 3
- Juvenile 3 - 10
- Adolescent 10+
Neuromuscular 10%
Neuropathic
- UMN: CP, FA, trauma
- LMN: Polio, SMA, Spina Bifida
Myopathic
- Muscular Dystrophy
- Myotonica
Congenital (10%)
Failure of Formation
- wedge vertebra
- hemivertebra
Failure of Segmentation
- unsegmented bar
- block vertebra
Mixed
Complex
Other (5%) NAOMI
Neurofibromatosis
Skeletal dysplasias
- Achondroplasia
- SED
- Mucopolysaccharidoses
- Diastrophic Dwarfism
Osteogenesis Imperfecta
Collagen disorders
- Marfan's
- Ehlers Danlos
Traumatic - fractures, surgical
Infective - vertebral osteomyelitis
Irradiation
Metabolic
- rickets, juvenile osteoporosis, osteogenesis imperfecta
Tumour - osteoid osteoma
Screening
Incidence of curve >30° is 3/1000 in USA
Screening controversial
- cost vs benefit
- increases health costs by 20% vs late fusion for severe disease only
- if believe that bracing works, then should believe in screening before Peak Height Velocity to decrease severe scoloiosis
- if don't believe in bracing, treat scoliosis as it comes later
- it is debatable whether condition is common enough to merit screening
WHO 5 Features of Screening Programme
1. Condition should be important problem
2. NHx should be known
3. An acceptable screening test
4. Acceptable treatment available
5. Programme should be cost effective
Screening Methods
1. Adam's Test
- bend forward with arms free
- Interobserver error
- no threshold value
2. Inclinometer / most common
- assess angular rib hump
- 7° threshold
- will miss 12% 20° curve, but decreases referral rate to 3%
- less sensitive
- more specific