Ortho

7/14/99

Classification of Scoliosis

1. nonstructural scoliosis

1. postural scoliosis—usually noted in later years of first decade—curves are always slight and disappear on lying down
2. compensatory scoliosis—usually a result of leg length discrepancy—pelvis dips down on the short side

1. transient structural scoliosis

1. sciatic scoliosis—not true scoliosis; an irritative form caused by pressure on nerve roots from a herniated disc
2. hysterical scoliosis—rare, usually requires psychiatric treatment
3. inflammatory scoliosis—seen w/perinphric abscess or similar infection

1. structural scoliosis

1. Idiopathic (genetic) scoliosis—about 70% of all cases of scoliosis. Classified by age of onset

1. infantile—before 3 y/o
2. juvenile—age 3 to onset of puberty, usually age 10
3. adolescent—from age 10 until maturity

1. Congenital scoliosis. Probably not genetic

1. w/neurologic deficit (myelomeningocele)
2. w/o neurologic deficit (spina bifida occulta)

1. neuromuscular scoliosis

1. neuropathic forms

1. lower motor neuron ds (polio)
2. upper motor neuron ds (cerebral palsy)
3. others (syringomyelia)

1. myopathic form
2. others (Friedreich's ataxia, unilateral amelia)

1. neurofibromatosis (von Recklinghausen's ds)
2. mesenchymal disorders

1. congenital (Marfan's syndrome, Morquio's ds, amyoplasia congenita, various types of dwarfism)
2. acquired (rheumatoid arthritis , Still's ds)
3. others (scheuermann's ds, osteogenesis imperfecta)

1. trauma

1. vertebral
2. extravertebral

Genetic Reasons

• 3° /yr. is progression measured by Cob's method
• handout of measurement of curvature
• ID the most inferior and superior that are inclined into the curve
• Line parallel to endplate and perpendicular
• Curve named by where the apex is located
• Thoracic is the most common
• Most progressive is thoracolumbar—lack of stabilization due to ribs
• Righting reflex
• Difference in distribution of red and white muscle fibers (not known if cause or effect)

• Ribs close together on concave side of curve widely separated on convex side. Vertebrae rotated w/spinous processes and pedicles toward concavity
• Posterior bulge of ribs on convex side forming characteristic rib hump in thoracic scoliosis
• SP deviated to concave side
• Rib pushed posteriorly thoracic cage narrowed
• Vertebral body distorted toward convex side
• Rib on other side pushed laterally and anteriorly
• Adam's sign—see rib hump
• Lamina thinner
• Vertebral canal narrower on concave side
• Hueter-Volkmann Rule: increased pressure on a vertebral epiphyseal growth plate will retard its rate of growth.
• Julius Wolfe—affect on bone throughout life

Clinical Evaluation

• Postural analysis
• Plum line—gauging trunk alignment
• True and apparent leg length factors
• Scoliometer—measurement of rib hump w/straight edge
• Increase in measurement, re x-ray

• Familial deposition—x-linked, can skip generations
• Situation
• Patient erect: double curve (right thoracic, left lumbar)
• Bending to left: thoracic curve increased; lumbar curve uncoiled (or reversed) indicating suppleness. Lumbar curve is nonstructural and minor
• Bending to right: lumbar curve increased; thoracic curve persists, indicating rigidity. Thoracic cure is structural and major

• x-ray
• PA films (increased risk of breast cancer)
• Lateral
• Left wrist and hand
• Greulich and Pyle—radiographic comparsion of chronologic age and tone growth (skeletal maturity) window of growth