- 737.30 Scoliosis (and kyphoscoliosis) idiopathic
- M41.20 Other idiopathic scoliosis, site unspecified
- 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
- Hemi-vertebrae malformation
- Infantile onset < 3 years old
- Juvenile onset 3 to 9 years old
- Adolescent idiopathic scoliosis (AIS) onset 10 to 18 years
- 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;
- Degree of curvature most commonly defined by the Cobb method,
- Increased risk of curve progression during growth spurts in
- 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
- 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
- Used to identify spinal cord and brain stem
- 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
- Occurs frequently in the general population
- 2 to 3% of the population
- 10% of adolescents have ...
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