- lateral curvature of the spine,
abnormal if the curve is more than 10
85% Idiopathic and the condition usually is
diagnosed during adolescence.
5% Congenital vertebral anomalies
- 10% other
skeletal anomalies (eg, rib
- 5% neuromuscular conditions (eg, CP, polio, spinal muscular
atrophy, muscular dystrophy, myelomeningocele, spinocerebellar degeneration, spinal anomalies:
- 5% misc: hereditary disorders (marfan, ehlers-danlos, neurofibromatosis,
etc), compensatory scoliosis (eg, leg length discrepancy).
- Positive family history is a
significant risk factor, no direct genetic link has been established.
- <3 years; males>females; classically left thoracolumbar curve;
resolves as child grows
- lateral curve is associated with vertebral rotation (thoracic spine),
chest wall deformity (rib hump), or flank prominence (lumbar spine). May
also see shoulder assymetry, unilateral scapular prominence, waist assymetry,
small chest, paralumbar bumps.
- In infants, hold baby prone on examiners hand.
- affected infants rapidly develop plagiocephaly with flattening of the
head on the concave side of the curve and corresponding prominence on the
opposite side of the head.
- must eval for GU tract anomalies esp unilateral renal agenesis
(increased incidence 20-30%, with congenital vertebral anomalies)
- may also see Klippel-Feil syndrome,
Sprengel deformity of scapula, neuromuscular
Juvenile Idiopathic Scoliosis: 4-10 years; males=females; 1/3-1/2 have
abnormality on MR
Adolescent Idiopathic Scoliosis: >11 years; more common in females; right
thoracic most common;
left thoracic curve assoc. with
underlying abnormality in 75% -MRI
Idiopathic scoliosis should be PAINLESS
Adolescent idiopathic scoliosis
a mild-to-moderate deformity
- that involves a radiographic
curve or Cobbs angle of less than 30
- and is associated with no complications or long-term disability.
- Except for severe curvatures of greater than 45 degrees , the
risk for curve progression ends with
skeletal maturity. Other factors
associated with curve progression include the magnitude of the
curve at diagnosis, a
thoracic curve, and the presence
of a double curve. Idiopathic
curves with a Cobbs angle greater than
45 degrees are at risk for progression in adulthood, and surgical treatment
may be recommended.
The Adams test is used to inspect
the spine for scoliosis.
- Adam's forward-bending test can be done in kids starting from age 6,
until the end of puberty.
- The clinician stands behind the patient, who bends forward at the waist 90 degrees,
keeping the knees extended.
- An elevation
or "hump" indicates asymmetry of one side compared with the other.
- A scoliometer, essentially a protractor that resembles a level, provides a
quantification of the asymmetry and aids in identifying progression or the need
for further evaluation.
- A scoliometer reading of 7 degrees or greater correlates
with a radiographic curve or Cobbs angle of 20 degrees.
- Radiographic curves
between 20 and 30 degrees have a higher
risk of progression in
immature girls compared with girls 2 years postmenarche.
- Obtain a PA standing x-ray of the lower cervical spine, the entire
thoracic and lumbar spine and the pelvis on a single film <- the gold standard
for evaluation of the degree of curvature. Use a 36 inch cassette.
- <25 degrees: follow, refer to ortho
- progressive curves of 25-40 degrees: brace if child has remaining growth (TLSO).
Bracing will not correct the curvature,
although it may help to slow the progression in skeletally immature
patients whose curves are less than 40 degrees.
- >40 degrees: surgery, spinal fusion
Referral to an orthopedic surgeon should
be considered for any
premenarcheal girl who has a Cobbs
angle greater than 20 degrees and any adolescent who has a Cobbs
angle greater than 40 degrees.
Peak height velocity usually occurs
after Sexual Maturity Rating stage 2 and before menarche. Accordingly, at
the growth spurt is probably ongoing and there is
an increased risk of progression of the spinal curvature prior to epiphyseal
- The daughters of mothers who have scoliosis are at increased risk, although the
severity of the daughter's scoliosis does not correlate with maternal severity.
Killian JT, Mayberry S, Wilkinson L. Current concepts in adolescent
idiopathic scoliosis. Pediatr Ann. 1999;28:755-761
Thompson GH, Scoles PV. Idiopathic scoliosis. In: Behrman RE, Kliegman RM,
Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa:
WB Saunders Co; 2000:2083-2086
CHLA Board Review 2005