Decrease in growth rate from the massive intrauterine growth. Still the growth rate is very high. Decreases up to age 4-5 and then plateaus. Then pubertal growth spurt.
By Duval Beaupere Scoliosis progression in two phases. Mathematical relationship Greater the velocity during the first period sharper will be the rise in the second Earlier the age at which puberty starts longer will be the second phase. Concept of Point P. Slope P1 and Slope P2.
Upper row all boys are 14.75 years old. Lower row all girls are 12.75 years old.
Go in detailed questioning about the nature of pain.
Uncommon for scoliosis to have neurological symptoms Scoliosis associated with kyphosis are more likely to have neurological complications Presence may indicate spinal cord anomaly
Curves more than 80 to 100. Ask for breathing difficulty Shortness of breath on running with friends Recurrent respiratory infections / hospitalizations
How to do a clinical and radiological workup?
Dr Kshitij Chaudhary
MS, DNB, Fellowship in Spine Surgery (USA).
Consultant Spine Surgeon
Sir HN Reliance Foundation Hospital
• Birth History
Issues in pregnancy?
Health of mother? Diabetic? Antenatal care appropriate?
Previous pregnancies ending in miscarriages?
Issues during perinatal and postnatal period
Term delivery? C-section or vaginal
ICU / ventilatory care
• Developmental History
Grade in School? Keeping up with peers
Menarche (record in yr+mo)
• Family History
Parents and their families (AIS, NM, NF)
Examine family if in room - Adam’s test
• Past medical or surgical history
Hearing / visual problems
Cleft lip/ palate
Tracheo-esophageal fistula, Anorectal problems
Cardiac murmurs / anomalies
Head to Toe
14+6y old girl who is 18 months postmenarchal
with right sided thoracic scoliosis,
probably adolescent onset idiopathic,
with trunk decompensation but without head
Keep it simple
Curve (side, location)