This document provides an overview of scoliosis, including definitions, classifications, causes, signs and symptoms, assessment, and treatment options. It defines scoliosis as a lateral deviation of the spine greater than 10 degrees with vertebral rotation. The main types discussed are idiopathic, congenital, neuromuscular, and adolescent. Treatment depends on the type and severity of scoliosis, and may include observation, bracing, casting, growing rods, or spinal fusion surgery. The goal of treatment is to prevent curve progression and deformity.

1. Scoliosis
DR ASAD ALI
ORTHOPAEDIC SURGEON
MAYO HOSPITAL LAHORE

2. Definition
Scoliosis-Greek word meaning “crooked”.
 It is defined as lateral deviation of the normal vertical
line of the spine, which when measured on the
radiographs, is greater than 10 degree, with
associated rotation of vertebrae.
 It is three dimensional deformity of spine-sagittal,
frontal and coronal.

3. Incidence and Etiology
 2 percent of children effect at same stage of their life.
 Girls are effected more than boys.
 Multifactorial in etiology, 80 percent idiopathic.
 Mostly patients have positive family history -11
percent risk in first degree relative.
 Related to hormonal, brainstem and proprioception
disorder.

4. Clinical Features
 Deformity is usually the Presenting Complaint
 Pain
 Rib hump due to asymmtry of trunk rotation (ATR
 Headache
 Neck pain
 Lower back pain
 Shoulder Elevation

5. Signs
 Raised scapula
 Waist line deformity
 Trunk shift
 LLD
 Cavovarus deformity
 Hips assymetry

6. Classification
 Structural: Radiographic Cobb angle greater than 25 degree
on ipsilateral bending radiographic views.
 Further classified into infantile, Juvenile, congenital and
adolescent(Age group), traumatic,Neuromuscular and
degenerative
 Non structural: Compensatory and postural i. e
 Postural scoliosis, hysterical scoliosis, contracture around hip
joint etc

7. Lenke classification
 Six curve types
 3 lumbar
 3 thoracic sagittal
 Helps to determine fusion levels during surgery
 Structural curves:
Largest curve, fails to bend to less than 25 degree
 Lumbar Modifier:
Based on position of CSVL in relation to apical vertebra of thorocolumbar
curve

8.  Type A:
CSWL is between the pedicles of the apical vertebra
 Type B:
CSWL touches between the concave pedicle and lateral
body
 Type C:
CSWL falls outside of apical vertebral body

10. Congenital Scoliosis
 It is progressive three dimensional deformity of the spine, caused by
congenital anomalies of the vertebrae, results in imbalance in
longitudinal growth.
 Developmental defect during 5th-8th week of gestation.
 High incidence of associated anomalies
 Intraspinal-20 to 40 percent, syringomyelia, thetered cord
 Cardaic-12 to26 percent,
 Genitourinary-20 percent, renal agensis, ectopic kidney
 3 basic types of defects-failure of segmentation, failure of formation
and mixed
 VACTERL association(vertebral defects,Anal atresia, Cardaic
anomalies, Tracheo-esophageal fistula, renal defects,limb defect

12. Neuromuscular Scoliosis
 Second most common form
 Associated with disorders of nerves and muscular system
 Neuropathic:
Lower motor neuron (Polio)
UMN(cerebral palsy)
 Myopathetic
progressive (muscular dystrophy)
Static(Amyotonia congenita)
others(Friedreich’s ataxia)

13. Idiopathic Scoliosis
 Most common tyoe
 No etiological factor
 Divided into three categories on the basis of chronological
age.
 Infantile:birth to 3 years
 Juvenile:3 years to 10 years
 Adolescent:10 years to 18 years

14. Infantile Scoliosis
 Male predominant
 Left sided thoracic curve patterm is present.
 Plegiocephaly often present.
 Congeintal defects may also be present.
 2 types - resolving, progressing; depends upon RVAD”position of medial
rib relative to apical vertebra.
 Phase 1:no overlap
RVAD less than 20 percent:80 percent chance of no progression
RVAD greater than 20 percent:80 percent chance of progression(Mehta
classification)
 Phase 2: rib overlap present with high risk of curve progression
 MRI is needed for evaluation of neural axis abnormalities.

16. Juvenile Scoliosis
 Most common in females
 Right thoracic curve most common
 High risk of progression, 95 percent in one study
 Least likely resoonds to bracing
 MRI needed for evaluation
 Rate of spinal cord deformity is 25 percent

17. Adolescent Scoliosis
 Most common scoliosis in children
 Female predominant
 Right sided thoracic curve
 Not associated with pain

18. Management

19. History
 Age of patient
 Duration
 Antenatal history
 Birth history
 Vaccination history
 Complete neurological history
 Family history

20. Examination
 Skin Inspection i. e tuft of hairs, local defect, curvature ,
symmetry of shoulder and iliac crest, foot shape
 Height measurement
 Assessmentvof pubertal development
 Neurlogical examination
 Gait

21. Assessment of Scoliosis
 Four parameters are evaluated
 Curvature
 Rotation
 Flexibility
 Skeletal maturuty

22. Scoliometry
 A scoliometer is placed on the
highest point on the upper back
curve and apex is measured

23. Plumb line
 On posterior aspect, a line drawn from
occiput and should allign with gluteal
cleft.

31. Imaging
 Standing full length PA radiograph, lateral radiograph, right
and left bending films, push prone radiograph
 Stagnara view:eliminate rotational component of cuve
 Radiographic, parameters to assess maturity, hand and
wrist(tanner white house) , development of iliac crest
apophysis(Risers sign), triradiate cartilage
 CT scan
 PFTs
 Echo
 MRI

45. Treatment

46. Infantile Scoliosis
 Resolving curves:
Observation e serial physical examination and
radiographic monitoring
Sleeping in prone position is recommended
 Progressive Curves:
Treated e serial casting followed by orthotic treatment

47. Treatment Options
 Serial casting plus bracing plus later fusion
 pre-oprative traction plus later fusion
 Growing rod or vertical expandable prosthesis titanium rib
(VEPTR)
 Best results obtained with in casting started before 20 months
and 60 degreee curve.
 Cast cahnges after every 2-4 months

51. Juvenile idiopathic Scoliosis
 Orthotic treatment is indicated if curves is witn in 25 to 30
degree.
 Surgical treatment is considered when curve magnitude
exceeds 50 degree.

54. Adolescent idiopathic scoliosis
 Depends on likelihood of cuve progression
 Obesrvation:skeletal immature patients with curve less than 20-25 degree
 Skeletally mature patuents with curve less than 45 degree
 Bracing:slow curve progression in skeletal immature patients(Risser 0-2)bracing doesn’t
reverse the curve.
 Indication:
 Curve of more than 25 degree or progression of 20 degree with documentation
progression
 Types:
 Milwaukee brace
 Throcolumbosacral brace
 Brace should wear 18 hours per day in risser 0
 It is dose dependant effective when wear more than 12 hours in a day

66. Thank you