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Condition/Disorder Synonym

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  • Kyphoscoliosis

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ICD-9-CM Code

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  • 737.30 Scoliosis (and kyphoscoliosis) idiopathic

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ICD-10-CM Code

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  • M41.20 Other idiopathic scoliosis, site unspecified

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Preferred Practice Pattern1

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Key Features

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Description

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  • 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 < 3 years old

  • Juvenile onset 3 to 9 years old

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

  • Adult onset >18 years

  • AIS is the most common form and occurs in otherwise healthy children during puberty (80 to 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

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Essentials of Diagnosis

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  • Adam's forward bending test

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

    • Exam 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 the inferior most acutely angles segment

      • The angle of intersection of two lines placed perpendicular to the above two lines is considered the Cobb angle for that lateral spine curvature

    • Lateral view to identify hyperkyphosis and/or lordosis

    • Also used to rule out primary structural or mass deformities causing a secondary scoliotic curvature

    • Cobb angle measurements: limited in ability to determine spinal flexibility and the three-dimensional aspect of the condition. Tends to overestimate the curve.

    • Cobb Angle measurements

      • <10 degrees is a normal variation and unlikely to progress

      • 10 to 35 degrees often treated conservatively, depending on rate of progression

      • >35 degrees considered for surgical intervention but guidelines and outcomes vary

      • >50 degrees considered surgical to prevent cardiopulmonary compromise, rib motion restriction, pain, cosmetic deformity

  • Skeletal maturity

  • MRI

    • Used to identify spinal cord and brain stem abnormalities

  • Three-dimensional computerized modeling techniques

    • Advanced computer modeling able to create three-dimensional images can reduce the number of x-rays needed to monitor scoliosis over time

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