Fig. 19.1
Adam’s forward bend test is a simple way to evaluate visually for asymmetry prior to obtaining radiographs
Curves may be present secondary to a leg length discrepancy which “disappear” when the inequality is corrected by standing on a full shoe lift. Therefore, in evaluating a curve on X-ray, attention must be paid to the pelvis to check for any discrepancy in height.
Scoliosis may be idiopathic, i.e., the exact cause is unknown, which is the form with which most physicians are familiar. It occurs in 2–3 % of the adolescent population and its etiology is generally considered to be multifactoral with a genetic predisposition. It occurs in females four times as frequently as in males. Treatment is required in approximately 1 out of 10 patients, and general recommendations include being fit for and wearing a full-time TLSO (thoracolumbosacral orthosis).
Non-idiopathic Scoliosis
Other types of scoliosis include congenital, neuromuscular, and infantile. Congenital scoliosis is where the curve is secondary to an embryologic defect in formation, segmentation, or both in the vertebral somites. Scoliosis occurs secondary to an asymmetry of growth of the vertebral bodies. This can be the result of a hemi-vertebra (Fig. 19.2) and butterfly vertebra (Fig. 19.3) or due to bars or block vertebrae. Neuromuscular scoliosis is secondary to an underlying neurologic/muscle disorder (Fig. 19.4). These curves are generally “C” shaped, i.e., long and sweeping. The curves may occur early in life and progress into adulthood. Muscle imbalance/weakness of varying causes is thought to be the etiology. Infantile scoliosis occurs from birth to age 4. Many of these curves will improve with time; however, some require treatment with serial casting or bracing.
Fig. 19.2
Scoliosis as a result of a hemi-vertebra
Fig. 19.3
Scoliosis as a result of a butterfly vertebra
Fig. 19.4
A long sweeping scoliosis is suggestive of an underlying neuromuscular disorder
Radiographic Evaluation
X-rays are the imaging modality of choice and should be obtained when scoliosis is clinically suspected. The central series to order would be a standing AP/lateral entire spine on a 14 × 36 film. If your patient is unable to stand or too young to stand, a sitting film will mimic the gravity picture of the spine, though its relationship to the pelvis will not be equally appreciated. The X-ray is systematically evaluated for overall alignment, vertebral anomalies, and bone quality. Each vertebra should have two pedicles and a spinous process similar to an owl’s face (Fig. 19.5). Once the general evaluation is complete, if a curvature is noted, it is precisely measured using the Cobb technique (Fig. 19.6a, b). True scoliosis is a curve greater than or equal to 10°.
