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  • Kyphoscoliosis

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  • 737.30 Scoliosis (and kyphoscoliosis) idiopathic

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  • M41.20 Other idiopathic scoliosis, site unspecified

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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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General Considerations

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  • Occurs frequently in the general population

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Demographics2

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  • 2 to 3% of the population
  • 10% of adolescents have ...

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