Diagnosis of Lordosis
Lordosis Diagnosis: Book Excerpts
Diagnostic Tests for Lordosis: Online Medical Books
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SCOLIOSIS:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there a history of trauma? Patients with scoliosis and a history of trauma should be suspected of having a thoracic or lumbosacral sprain, fracture, or herniated disk.
- Is the neurologic examination abnormal? Abnormal neurologic findings should suggest poliomyelitis, muscular dystrophy, multiple sclerosis, syringomyelia, Friedreich's ataxia, and many other disorders.
- If the neurologic examination is abnormal, are there motor findings only or both sensory and motor findings? Abnormal motor findings would suggest poliomyelitis or muscular dystrophy, whereas abnormal sensory and motor findings would suggest multiple sclerosis, syringomyelia, and Friedreich's ataxia, among other disorders.
- Does x-ray show bone disease? Diseases of the bone that may cause scoliosis are Paget's disease, osteoporosis, destructive disease of the vertebrae such as tuberculosis, osteogenesis imperfecta, rickets, congenital hemivertebra, and Klippel-Feil syndrome.
- If x-ray shows bone disease, is the patient a child or an adult? Children with scoliosis and bone disease may have rickets, osteogenesis imperfecta, congenital hemivertebra, and Klippel-Feil syndrome. Adults with x-ray changes of bone diseases may have Paget's disease, osteoporosis, destructive disease of the vertebrae, and other disorders.
- Is one leg shorter than the other? A short leg would suggest congenital or acquired short-leg syndrome.
DIAGNOSTIC WORKUP
The vast majority of mild cases of scoliosis require only x-rays and watchful expectancy or referral to an orthopedic surgeon. Routine diagnostic workup may include a CBC, sedimentation rate, urinalysis, chemistry panel, arthritis panel with ANA and HLA B27 antigen, tuberculin test, and a spinal survey including both recumbent and upright views. A bone survey may need to be done also. A bone scan may be necessary to detect subtle bone disease. If these tests are negative, the patient should be referred to an orthopedic surgeon. EMG examinations, nerve conduction velocity studies, CT scans, and MRIs may be necessary. Remember, scoliosis is rarely the cause of back pain unless the spinal angulation exceeds 40 degrees.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Scoliosis & Kyphosis:
Differential Diagnosis
(In a Page: Signs and Symptoms)
Scoliosis
- Idiopathic (75–80% of cases) scoliosis usually occurs in otherwise healthy patients; pain and neurologic deficits are rare; right thoracic curve is most common, then double curve (right thoracic and left lumbar); named by convex side
–Infantile (birth to 3 years): Rare in the U.S.
–Juvenile (4–10 years): Uncommon
–Adolescent (11 years to skeletal maturity):
Occurs mostly in females
-
Neuromuscular scoliosis
–Common with paralytic disorders
–More severe, almost always progressive
-
Congenital scoliosis
–Failure of formation or segmentation
Kyphosis
-
Postural roundback
-
Scheuermann's disease
–Second most common pediatric spinal deformity
–Cannot voluntarily correct
–Angulation in mid- to low-thoracic spine
-
Congenital kyphosis
Less common etiologies (“zebras”)
-
Post-thoracotomy
-
Marfan's syndrome
-
Neurofibromatosis
-
Achondroplasia
-
Diastrophic dwarfism
-
Specific neuromuscular disorders (e.g., cerebral palsy, syringomyelia, polio, muscular dystrophy, cord tumor/trauma)
Workup and Diagnosis
-
History and physical examination, including peripheral neurologic exam
–Scoliosis: Inspect the back, shoulders, and pelvis for scapular prominence; rib prominence (especially with Adams forward bend test), shoulders, or pelvis not level; “rib hump” measured with scoliometer on bending; assess decompensation by using plumb bob to measure location of C7 with respect to gluteal cleft
–Kyphosis: Inspect the spine for curve greater than normal of 25–45° in the thoracic spine; assess patient's ability to extend to correct curvature
- A/P and lateral X-rays of entire spine with extra long cassette (scoliosis series)
- Scoliosis: Curve is measured by Cobb method (angle between the axes of the inferior and superior vertebrae with maximal tilt)
–Stagnara view for severe curves: A/P X-ray of vertebral bodies
–Bending versus traction views if surgery is contemplated
–MRI or CT if abnormal neurologic exam, unusual curves, rapid progression, or congenital
–Pulmonary function tests are indicated in severe disease to evaluate for pulmonary dysfunction due to decreased rib cage space - Kyphosis: Supine hyperextension films
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Scoliosis:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Idiopathic scoliosis
–Lateral deviation or curvature of either the
thoracic or lumbar spine greater than 10°
–Right thoracic curves are most common
–Usually presents in early adolescence
–Girls > boys
-
Risk factors for progression
–Curve >20°
–Age less than 12
–Skeletal maturity, Risser stage 0–1
-
Infantile idiopathic scoliosis
–Presents at 0–3 years old
–Left thoracic curve more common
–Boys > girls
–85% spontaneously resolve
–Must rule out spinal cord disease or
congenital cause of scoliosis
-
Juvenile idiopathic scoliosis presents at 3–10 years old and is similar to adolescent (idiopathic) scoliosis
- Neuromuscular scoliosis
–Related to cerebral palsy, muscular dystrophy, myotonic myopathy, and spinal muscular atrophy
–Tends to progress more rapidly and even continues after maturity, as compared to idiopathic scoliosis
–Pulmonary complications seen with severe curves >90°
-
Congenital scoliosis
–Failure of formation or segmentation of spinal vertebra
–Rapid progression and worse prognosis is associated with unilateral unsegmented bar with contralateral hemivertebra
-
Other causes
–Tumor, infection, neurofibromatosis, metabolic bone disorders, and Marfan syndrome
Workup and Diagnosis
-
Generally patients are referred after either school screening for scoliosis or well-child check
-
History
–Painful symptoms in the history should be a red flag to
rule out infection, tumor, or spinal cord anomaly
–There is often a positive family history
- Clinical examination
–Careful neurologic examination
–Moderate to severe curves demonstrate shoulder and waist asymmetry, trunk shift, and limb length inequality
–Forward bending test: Examiner stands behind patient while patient bends forward from the waist, hands hanging down, feet together and knees straight, evaluating for rib hump or depression or asymmetric paravertebral muscles
–Scoliometer may be used to measure rotational deformity (>7° requires radiographic evaluation)
- Radiographic studies
–X-ray: Standing AP and lateral radiographs allow measurement of curves by Cobb method (Cobb angle is made by line drawn along superior endplate of uppermost tilted vertebra and a line drawn along inferior endplate of lowest vertebra in curve)
–MRI indicated for neurologic compromise, excessive kyphosis, onset of scoliosis after age 11 years, rapid curve progression, structural abnormalities noted on plain X-ray, and left thoracic or thoracolumbar curves
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Scoliosis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
CONFIRMING DIAGNOSIS Anterior, posterior, and lateral spinal X-rays, taken with the patient standing upright and bending, confirm scoliosis and determine the degree of curvature (Cobb method) and flexibility of the spine.
A scoliometer can also be used to measure the angle of trunk rotation. Physical examination reveals unequal shoulder heights, elbow levels, and heights of the iliac crests. Muscles on the convex side of the curve may be rounded; those on the concave side, flattened, producing asymmetry of paraspinal muscles.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Scoliosis:
Diagnosis
(Handbook of Diseases)
Anterior, posterior, and lateral spinal X-rays, taken with the patient standing upright and bending, confirm scoliosis and determine the degree of curvature (Cobb method) and flexibility of the spine. (See Cobb method for measuring angle of curvature.) A scoliometer can also be used to measure the angle of trunk rotation.
A physical examination reveals unequal shoulder heights, elbow levels, and heights of the iliac crests. Muscles on the convex side of the curve may be rounded; those on the concave side, flattened, producing asymmetry of paraspinal muscles.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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