A 12-year-old girl presents to the office after a routine school screening. She was told that she has an abnormal curvature of her spine, and she notes an unpleasant hump on the right side of her back. She is found to have a right sided prominence, shoulder height differences, and lateral curvature of her spine on examination (Figures 91-1 and 91-2). Neurological examination is normal. PA and lateral x-rays are taken, and the patient is referred to a Pediatric Orthopedic surgeon for evaluation and management.
Typical scoliosis deformities that are seen on forward-bending clinical examination in a 12-year-old girl. Note the thoracic prominence on the right and the sloping angle from the right back to the left. (Used with permission from David Gurd, MD.)
Typical scoliosis deformities that are seen on posterior clinical examination of the same girl as in Figure 91-1. Note the assymetry of the scapulae and the waist contours. The curvature of the spine is visible along with a slightly higher right shoulder too. (Used with permission from David Gurd, MD.)
Scoliosis is a lateral curvature of the spine that is greater than 10 degrees in the coronal plane (Figure 91-3). It is often associated with rotational changes and hypokyphotic spinal deformity (flat thoracic spine when viewed from the side).1
Example of rotational deformity that occurs with scoliosis. Notice how the vertebral body rotates out toward the apex and convexity of the curve. The majority of the rotation is located nearest to the apex, less away from the apex. (Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 2012. All Rights Reserved.)
Back curvature; spine deformity; twisted spine.
Overall incidence in the population is 2 to 3 percent, with 0.1 to 0.3 percent of the population developing significant curves exceeding 20 degrees.2
Scoliosis is classified as:
Congenital—Arising from congenital (as an infant) vertebral anomalies such as wedged vertebrae, hemivertebrae, and fused/unsegmented vertebrae.
Infantile Idiopathic Scoliosis—Scoliosis which is present between birth and 3 years of age without congenital change. This comprises 4 percent of all idiopathic scoliosis cases.3
Juvenile Idiopathic Scoliosis—Scoliosis which develops between 4 and 10 years of age. This comprises 10 to 15 percent of all idiopathic scoliosis cases.4
Adolescent Idiopathic Scoliosis (AIS)—Scoliosis which develops between 10 and 18 years of age. This is by far the most common form of scoliosis.
Etiology and Pathophysiology