140: SCOLIOSIS (KYPHOSCOLIOSIS) IDIOPATHIC

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

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

• Adam’s forward bending test

  • 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 ...