Scoliosis

Scoliosis is characterized by the lateral deviation of the spine from its normal position and is associated with rotation of the vertebrae. Scoliosis may be caused by a structural spine deformity or another problem (e.g., unilateral leg shortening) or may be a protective reaction of muscle spasm in the back for lumbar disk disease or inflammation. Of the structural causes, idiopathic scoliosis is most common, affects women more frequently, and is often asymptomatic in young people. Other causes include neurologic deficit,

the chest shows rib distortion resulting from vertebral rotation. (Redrawn from Mercier R. Practical Orthopedics, 5th ed. St Louis, Mosby, 2000, p 132.)

myopathy, and neurofibromatosis; presence of pain may signify another cause.

The patient with scoliosis may present with apparent deformity, pain, symptoms of difficult movement, or neurologic deficits. The examiner stands behind and observes the patient bending forward at the waist with arms loosely directed toward the feet, which may reveal a prominence of the ribs on one side of the back of the chest and abnormal curvature of the spine (Fig. 31-24). Worsening scoliosis may result in pain, progressive deformity, disability, and cardio-pulmonary compromise.

Radiographs aid in the diagnosis and also allow measurement of the angle of curvature of the spine (Fig. 31-25). MRI may be indicated if there are additional symptoms, such as pain or neurologic problems. Early detection is important, and prompt referral to specialists is indicated in certain cases. Spinal growth continues until bone growth has been completed, and serial radiographs are useful to monitor the condition.

Treatment of scoliosis is primarily based on severity and angle of curvature. Braces may be recommended and in special cases, surgery (Janicki and Alman, 2007; SOR C, 3).

Figure 31-25 Cobb method of measuring the severity of a curve. Upper and lower end vertebrae are identified. Upper end vertebra is higher, its superior border converging toward the concavity of the curve, and lower end vertebra has inferior border converging toward the concavity. Lines are drawn along these borders, and the curve is measured directly (a) or geometrically (b). (Redrawn from Mercier Rl Practical Orthopedics, 5th ed. St Louis, Mosby, 2000, p 132.)

References

The complete reference list is available online at www.expertconsult.com.

Web Resources

www.ninds.nih.gov/disorders/backpain/backpain.html

Information on back pain with links to other sites, including clinical trials in the U.S. and worldwide. www.aaos.org/research/research.asp

American Academy of Orthopedic Surgeons site that includes Clinical Practice Guidelines, Research News, and information about common musculoskeletal disorders.

www.nlm.nih.gov/medlineplus/neckinjuriesanddisorders.html www.familydoctor.org

Consumer health information on a variety of disorders, provided by the American Academy of Family Physicians.

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