SCOLIOSIS
SCOLIOSIS: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- 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.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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