Scoliosis
Scoliosis is a lateral curvature of the spine greater than 10 degrees by Cobb angle on standing radiographs, most often adolescent idiopathic scoliosis detected on screening with the forward bend test. Treatment follows the Cobb angle and remaining growth: observation for 11-24 degrees, bracing for 25-49 degrees while growth remains, and surgical fixation at 50 degrees or more, with restrictive lung disease the main long-term risk of severe curves.
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What this article covers
- Overview
Scoliosis is a lateral curvature of the spine greater than 10 degrees by Cobb angle, involving the thoracic (most common), lumbar, or thoracolumbar spine, with vertebral rotation and sidebending.
- Epidemiology
Scoliosis affects about 2%-3% of the population, predominantly adolescents during rapid skeletal growth.
- Risk factors
Family history increases the risk of developing adolescent idiopathic scoliosis.
- Pathophysiology
In idiopathic disease, the spine grows asymmetrically during the pubertal growth spurt, producing a lateral curve with rotation of the vertebrae toward the convexity.
- Clinical features
Most patients are asymptomatic and are found on screening: the hallmark is a thoracic or lumbar prominence on the Adams forward bend test, the most sensitive clinical test.
- Differential diagnosis
Spinal tumor or spinal cord compression: progressive or severe back pain with neurologic deficits, unlike painless idiopathic scoliosis; requires urgent MRI.
- Diagnosis
The diagnosis is established radiographically: a Cobb angle greater than 10 degrees on standing posteroanterior and lateral full-length spine radiographs confirms scoliosis, and the same Cobb angle…
- Management
First, exclude a secondary cause: red-flag features mandate MRI and treatment of the underlying lesion (syrinx, tumor, infection, tethered cord) before curve-based management.
- Complications
Restrictive lung disease from severe thoracic curves reduces lung volumes and chest expansion and can progress to pulmonary hypertension, cor pulmonale, and respiratory failure.
- Prognosis
Once skeletal maturity is reached, the risk of curve progression is minimal, which is why monitoring and bracing are confined to the growth period.
- Prevention
Screen with the Adams forward bend test and scoliometer at preadolescent and adolescent preventive visits, obtaining radiographs for an angle of trunk rotation of 7 degrees or more (5 degrees or more if overweight).
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