Scoliosis Classification

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