Scoliosis & Kyphosis

Scoliosis & Kyphosis: Excerpt from In a Page: Signs and Symptoms

Scoliosis is a curve of the spine in the coronal plane (i.e., lateral curve) that is often associated with a rotational deformity as well. Kyphosis is an alteration in normal spinal curvature in the sagittal plane, and it refers to a curve with an anterior concavity. Normally, some degree of thoracic and sacral kyphosis exists. Lordosis (convex anterior) is normal in the cervical and lumbar spines.

Differential Diagnosis

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

Treatment

• Scoliosis
  –Treat underlying cause if applicable (e.g., tumor)
  –<20–25° of deformity: Observation
  –20–40° of deformity: Bracing (preferably to be worn 23 hours/day); bracing stops progression only; Milwaukee brace (includes neck ring) gives best results but poor compliance; lumbosacral orthosis (Boston brace) has poorer results but better compliance
  –>40° of deformity: Surgery (posterior spinal fusion with rods) is usually indicated; progression is very likely
  –More aggressive treatment is usually indicated if progression >5°, female, younger, or if secondary, treatment generally more aggressive
• Kyphosis: Bracing or surgery, similar to scoliosis
>

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Scoliosis

• Back to disease: Scoliosis: Introduction
• Next Book Extract About Scoliosis: Scoliosis (In A Page: Pediatric Signs and Symptoms)
• More Book Extracts: All Online Books for Scoliosis

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

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Scoliosis (In A Page: Pediatric Signs and Symptoms)

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• Scoliosis (Professional Guide to Diseases (Eighth Edition))
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• Know how to recognize and manage scoliosis because an early diagnosis and treatment are especiallyimportant to prevent serious consequences (Avoiding Common Pediatric Errors)

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