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Scoliosis

R. A. Lovell FRCS(orth)

Skoliosis (Gr): Crookedness

Normally taken to mean lateral curvature of the spine. In fact, usually a triplanar deformity comprising lateral curvature with rotation and sagittal plane deformity (usually lordosis or hypokyphosis).

Subdivided into:

1) Idiopathic- cause unsure.

  • Infantile Below 3 years
  • Juvenile 3-10 years
  • Adolescent 10 years - skeletal maturity.

2) Secondary- identifiable cause.

  • Congenital
  • Neuromuscular
  • Degenerative
  • Post trauma/tumour/infection
  • Postural

Idiopathic Scoliosis

Aetiology

Still unknown. Many theories suggested.
Multifactorial.
Strong genetic predisposition.
Abnormalities in platelet calmodulin levels suggested.
Melatonin synthesis and metabolism implicated.

Biomechanics

Overgrowth of anterior column leads to buckling and rotation of the vertebral column. Spinous process deviates into concavity.
Heuter-Volkmann law states that pressure on epiphysis retards growth whilst distraction increases growth (consider Blount's!). This is thought to explain curve progression.
Characteristic deformities- lateral curvature, rotation, lordosis & wedged vertebrae.


Infantile Idiopathic

More common in males cf adolescent.
Convex to left cf adolescent.
Not present at birth.
Associated hip dyplasia and plagiocephaly.
Must exclude- neuromuscular, congenital, myelodyplasia, intradural pathology.
Assess with  plain radiographs- curve magnitude and pattern
 MRI- ?underlying abnormality.

Fig.1 Rib Vertebral Angle Difference of Mehta (Mehta JBJS(Br) 54:230 1972).

 

Measure difference between sides (RVAD)- a measure of rotation.
If <20 degrees- low risk of progression.

Treatment:

If Cobb angle <25 degrees, RVAD <20 degrees observe.
May resolve spontaneously.
If more than this serial casting and bracing.
Surgery for failed bracing or rapid progression.
Options- Instrumentation without fusion- preserves

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