SCOLIOSIS

SCOLIOSIS: Excerpt from Differential Diagnosis in Primary Care

The many causes of this deformity of the spine can be recalled by applying the mnemonic MINTS. M—Malformation prompts the recall of osteogenesis imperfecta, congenital hemivertebra, Marfan syndrome, and arthrogryposis. It should also suggest a short leg syndrome. I—Inflammation suggests tuberculosis and fungal disease of the spine. The I should also remind one of idiopathic scoliosis, responsible for 80% of the cases. N—Neurologic disorders that may cause scoliosis include syringomyelia, poliomyelitis, muscular dystrophy, and Friedreich ataxia. T—Trauma should facilitate the recall of thoracolumbar sprain, compression, fracture, and herniated disc. It should also remind one of thoracoplastyand other surgical causes. S—Systemic disease associated with scoliosis include Paget disease, pulmonary fibrosis, and Ehlers–Danlos syndrome. Unfortunately, rickets and osteoporosis will not be recalled with this mnemonic.

Approach to the Diagnosis

Most causes of scoliosis will require only an x-ray of the spine to clarify the diagnosis. An orthopedic consult should be obtained before any further workup. Be sure to measure the leg length. If there are objective neurologic signs, a neurologist should be consulted. A bone scan, MRI, or computed tomography (CT) scan may be necessary in difficult diagnostic problems.

Other Useful Tests

1. Complete blood count (CBC) (osteomyelitis)
2. Sedimentation rate (osteomyelitis, tuberculosis)
3. Arthritis panel (rheumatoid spondylitis)
4. Human leukocyte antigen (HLA) B-27 (rheumatoid spondylitis)
5. Pulmonary function tests (pulmonary fibrosis)
6. Bone survey (Paget disease)
7. Electromyogram (EMG) (muscular dystrophy)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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