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Key Features

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  • Characterized by lateral curvature of the spine associated with rotation of the involved vertebrae and classified by its anatomic location, in either the thoracic or lumbar spine, with rare involvement of the cervical spine

  • There are four main categories

    • Idiopathic

      • Accounts for around 80% of cases

      • More common in girls

      • Typically develops around 8–10 years of age, but can occur earlier

      • There is a genetic component

    • Congenital

      • Accounts for 5–7% of cases

      • Results from vertebral abnormalities due to a failure of formation or segmentation of the affected vertebrae

    • Neuromuscular (associated with a neurological or muscular disease)

    • Syndromic (associated with a known syndrome)

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Clinical Findings

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  • Does not typically cause significant pain

  • If a patient has significant pain, she/he should be evaluated to rule out the possibility of some other disorder such as infection or tumor

  • Deformity of the rib cage and asymmetry of the waistline are clinically evident for curvatures of 30 degrees or more

  • Lesser curves may be detected through a forward bending test, which is designed to detect early abnormalities of rotation that may not be apparent when the patient is standing erect

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Diagnosis

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  • Radiographs taken of the entire spine in the standing position in both the posterior anterior (PA) and lateral planes are the most valuable for diagnosis

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Treatment

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  • Depends on the curve magnitude, skeletal maturity, and risk of progression

    • Curvatures of less than 20 degrees typically do not require treatment unless they show progression; bracing is controversial but often used for curvatures of 20–40 degrees in a skeletally immature child

    • Curvatures greater than 40 degrees are resistant to treatment by bracing

    • Curvatures reaching a magnitude of 40–60 degrees are indicated for surgical correction as they are highly likely to continue to progress

    • Thoracic curvatures greater than 70 degrees have been correlated with poor pulmonary function in adult life, leading treatment algorithms toward preventing progression to this extreme

    • Curvature that demonstrates progression on serial radiologic examination

  • Surgical intervention consists of spinal instrumentation and fusion

  • Definitive spinal fusions should be delayed as long as possible in young children through the use of casting, bracing, and growth modulating surgeries such as growing rods or vertical expandable prosthetic titanium ribs

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