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Scoliosis

Scoliosis is defined as lateral curvature of the spine with rotation. A lateral curvature of the spine without rotation is not scoliosis. It has to be greater than 10ļ and that is as per the Scoliosis Research Society definition of scoleosis. There is no known etiology, thus the word idiopathic. We donít know. There is a female predominance.

There are three types that we know: Infantile which occurs from birth to three years. This is the only one that has a male predominance seen in Great Britain for some reason more than in North America. It is very rare in North America and it is associated with plagiocephaly and DDH. Juvenile idiopathic scoliosis is from age 4 to 10 years, females greater than males. Adolescent is generally that seen after 10 years. It is the most common form. Again females are

Scoliosis. This is curvature of the spine with rotation. That is scoliosis. There is a curve here and how do you know there is rotation? Because the ribs are twisted. If the ribs are twisted, there is rotation. If the ribs are not twisted, then there is no rotation and it is not scoliosis.

Take a good history. If a patient says, "Yeah, Iíve got this curve and my back has been hurting ever since I got it." That is abnormal. Back pain is usually not associated with adolescent idiopathic scoliosis although14% will have pain some time during their treatment. So it is not an absolute rule. I donít blow off kids with back pain as just being painful scoliosis.

 I work them up for back pain, not for scoliosis. If they have neurologic signs or hamstring tightness, again, they get the back pain workup, not the scoliosis workup. Do a physical examination on these kids. Basically, itís an Adamís forward bend test with the pelvis level. Make sure the pelvis is level because if it isnít, that can cause curvature of the spine but it is not scoliosis. Check the rotation of the spine and that you do by looking at the ribs. Look for a rib hump and look at the sagittal alignment. Step out from behind them and look at them from the side. Thatís how you see that kid with the big hump of the Scheuermannís kyphosis.

Here is a curve here that is worse than this one. That measures probably about 25ļ but again there is no rotation here. The spine is straight. Rotationwise it is just curved to the left and this is what she looks like clinically. There is no way that she doesnít have scoliosis except they sent her to a psychiatrist and she got better. It was some sort of a transference or something. Itís a scoliosis. Thatís what we call it and it happens more often in girls than boys. I donít want to explain that. I have no explanation for it but some things arenít scoliosis. If you donít see rotation, then it is not scoliosis. Think about something else. Leg length discrepancy.

When you do have it, what do you do? Well, we screen in school and screening is controversial. The National Institutes of Health have come out against school screening. The American Academy of Orthopaedic Surgery, Scoliosis Research Center and American Academy of Pediatrics have all come out for school screening. So I donít know where you stand on that but I do it and I recommend.

There is a high false positive rate with scoliometer readings. Especially if you use 5ļ as your cutoff to refer them to an orthopedic surgeon, you will have a 36% high false positive rate. I think that is why the Scoliosis Research Society has adopted 7ļ for a minimum to refer because that is associated with a 20ļ Cobb Angle. That is the angle you measure on the x-ray. This is inexpensive and noninvasive. It is very easy to do and if you have a patient with a greater than 7ļ scoliometer reading, the child should probably get an x-ray because he probably has a curve greater than 20ļ. They should be 36" standing x-rays.

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