Scoliosis in Pediatric Age
Scoliosis
Scoliosis is a three-dimensional deformity of the spine characterized by lateral curvature >10° in the coronal plane, accompanied by vertebral rotation.
Key Points
- Prevalence: 2-3% of adolescents
- Female:Male ratio = 7:1 for curves requiring treatment
- 80% are idiopathic
- Screening typically done during school years
- Growth potential is crucial for progression risk
1. By Age of Onset
- Infantile (0-3 years):
- Resolving type (spontaneous resolution)
- Progressive type (requires treatment)
- Often associated with other conditions
- Juvenile (4-10 years):
- Higher risk of progression
- Requires close monitoring
- Adolescent (>10 years):
- Most common type (80%)
- Progressive during growth spurts
- Adult (after skeletal maturity):
- De novo scoliosis
- Progression of adolescent curves
2. By Etiology
- Idiopathic (80%):
- No identifiable cause
- Genetic predisposition likely
- Congenital:
- Formation defects (hemivertebrae)
- Segmentation defects (bars)
- Mixed defects
- Neuromuscular:
- Upper motor neuron:
- Cerebral palsy
- Syringomyelia
- Spinal cord injury
- Lower motor neuron:
- Poliomyelitis
- Spinal muscular atrophy
- Myopathic:
- Duchenne muscular dystrophy
- Arthrogryposis
- Upper motor neuron:
- Syndromic:
- Marfan syndrome
- Ehlers-Danlos syndrome
- Neurofibromatosis
3. By Curve Pattern
- Single curves:
- Thoracic (most common)
- Thoracolumbar
- Lumbar
- Double curves:
- Double thoracic
- Thoracic and lumbar
- Triple curves
Signs and Symptoms
- Physical findings:
- Shoulder asymmetry
- Scapular prominence
- Trunk shift
- Rib hump (on forward bend)
- Waistline asymmetry
- Leg length discrepancy
- Symptoms:
- Usually asymptomatic in adolescents
- Back pain (more common in adults)
- Respiratory symptoms (severe curves)
- Psychological impact
Physical Examination
- Adams forward bend test
- Scoliometer measurement
- Neurological examination
- Skin examination (café-au-lait spots)
- Assessment of flexibility
- Evaluation of skeletal maturity
Imaging Studies
- Radiographs:
- Standing PA and lateral spine
- Side-bending films
- Cobb angle measurement
- Nash-Moe rotation grading
- Risser sign assessment
- Advanced imaging:
- MRI indications:
- Early onset scoliosis
- Rapid progression
- Atypical curves
- Neurological findings
- CT scan:
- Congenital anomalies
- Surgical planning
- MRI indications:
Treatment Options
- Observation:
- Curves <20°
- Regular follow-up
- Bracing:
- Indications:
- Curves 25-45°
- Skeletal immaturity
- Progressive curves
- Types:
- TLSO (Boston brace)
- Charleston bending brace
- Milwaukee brace
- Providence brace
- Indications:
- Surgical Treatment:
- Indications:
- Curves >45-50°
- Progressive curves
- Failed conservative treatment
- Techniques:
- Posterior spinal fusion
- Anterior spinal fusion
- Combined approaches
- Growth-friendly techniques for EOS
- Indications:
Early Onset Scoliosis (EOS)
- Special management principles:
- Serial casting
- Growth-friendly implants
- Regular lengthening procedures
- Types of growing systems:
- Traditional growing rods
- MAGEC rods
- VEPTR
- Shilla growth guidance
Adult Scoliosis
- De novo vs. Progressive AIS
- Focus on:
- Pain management
- Curve progression
- Sagittal balance
- Neurological symptoms
Conservative Treatment
- Brace-related:
- Skin problems
- Psychological impact
- Compliance issues
Surgical Complications
- Early:
- Neurological injury
- Infection
- Blood loss
- Late:
- Pseudarthrosis
- Adjacent segment disease
- Implant failure
- Proximal junctional kyphosis
Natural History Complications
- Progression risk factors:
- Skeletal immaturity
- Curve magnitude
- Curve pattern
- Long-term effects:
- Chronic pain
- Respiratory compromise
- Psychological impact
- Decreased quality of life
