Chapter 140

### CONDITION/DISORDER SYNONYM

• Kyphoscoliosis

### ICD-9-CM CODE

• 737.30 Scoliosis (and kyphoscoliosis) idiopathic

### ICD-10-CM CODE

• M41.20 Other idiopathic scoliosis, site unspecified

### PREFERRED PRACTICE PATTERN

• 4B: Impaired Posture

PATIENT PRESENTATION

A 16-year-old girl is referred to your outpatient physical therapy clinic. The patient comes with her mom. The patient states she has been going to cheerleading practice and is having back pain. The referring physician told her she had scoliosis with a Cobb angle of 27 degrees. They do a lot of stretching in cheerleading practice, but she is having difficulty with the backward bends. She is starting to have some instability in the thoracic spine with localized pain and erector spinae spasms.

#### KEY FEATURES

##### Description

• Three-dimensional curvatures of the spine and trunk

• Lateral curve is an S- or C-shaped curve in the sagittal plane

• Torsional component with vertebrae rotating toward the convexity

• Anteroposterior distortion leads to hyperkyphosis and/or hyperlordosis in the coronal plane

• Functional lateral curvature of the spine, typically reversible

• Structural lateral curvature of the spine, fixed

• Most commonly idiopathic

• May be present in conjunction with another condition

• 80% to 85% are idiopathic

• Congenital

• Hemi-vertebrae malformation

• Infantile onset: Younger than 3 years

• Juvenile onset 3 to 9 years old

• Adolescent idiopathic scoliosis (AIS) onset 10 to 18 years old

• Adult onset: Older than 18 years

• AIS is the most common form and occurs in otherwise healthy children during puberty (80%–85% of cases)

• Relatively benign condition

• Named for the side of the convexity of the lateral curve (right, dextroscoliosis; left, levoscoliosis)

• Degree of curvature most commonly defined by the Cobb method, radiographically

• Increased risk of curve progression during growth spurts in adolescents

##### Essentials of Diagnosis

• Patient stands with back to the clinician and then actively bends forward toward the floor.

• Examination reveals a rib hump, which represents the posteriorly displaced rib angles due to vertebral rotation on the convex side of the curve.

• Functional: During forward bending, the rib hump disappears with ipsilateral side bending.

• Structural: During forward bending, the rib hump persists with ipsilateral side bending.

• Inclinometer measuring device may be utilized to clinically document progression or regression of curve without radiation exposure.

• X-rays (occiput to sacrum) used to define severity of curve.

• Anteroposterior view with Cobb angle measurements

• A perpendicular line at the top of the vertebral body of the superior most acutely angles vertebral segment intersecting a similar line at ...

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