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Scoliosis

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Overview

Scoliosis describes the lateral curvature of the spine. It may be S- or C-shaped. It usually occurs in 3 dimensions. It can be described as:

  • Structural scoliosis – where spinal curvature is due to problems within the bone itself
  • Functional scoliosis – where spinal curvature is due to an extraspinal cause (e.g. muscle tone asymmetry) 

Classification

  • Infantile scoliosis – before 3 years old, more common in boys
  • Juvenile scoliosis – ages 3-10 years old, more common in girls
  • Adolescent idiopathic scoliosis – >10 years old, more common in girls
  • Adult scoliosis – after maturity

Causes

  • Idiopathic – around 80% of cases
  • Congenital spinal malformation – around 10% of cases
  • Neuromuscular disorders (e.g. cerebral palsy and spina bifida) – around 15% of cases

Risk Factors

  • Family history
  • Growth spurt – scoliosis is likely to become more apparent during the growth spurt

Presentation

Overview

Presentation ranges from asymptomatic to back pain and cardiorespiratory problems if severe.

  • Patients may have asymmetrical shoulder levels, hip asymmetry, or rib prominence

Investigations

Overview

  • Posteroanterior and lateral X-rays of the spine:
    • Identifies scoliosis
    • Cobb’s angle is measured and is >10°
  • MRI spine:
    • If neurological abnormalities are present to assess the integrity of the spinal cord

Management

Overview

Management may involve observation, orthosis (external devices such as braces to support the spine), or surgery in severe or progressive structural scoliosis.

Complications

  • Respiratory muscle weakness and shortness of breath on exertion
  • Spinal cord impingement/compression causing neurological abnormalities
  • Psychological problems such as poor self-esteem

Prognosis

  • The prognosis depends on skeletal maturity and the degree of curvature. Scoliosis can progress during skeletal growth and a in general, greater degree of curvature is associated with a worse prognosis.
  • Treatment with orthoses is less likely to be effective if scoliosis is progressive and surgery is more likely to be necessary.

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