Adolescent idiopathic scoliosis

A degree of scoliosis is detectable in 5% of the adolescent population. 3 The vast majority of curves, occurring equally in boys and girls, are mild and of no consequence. Eighty-five per cent of significant curves in adolescent scoliosis occur in girls. 4 Inheritance is a factor. The highest incidence is in first degree female relatives (12%). The scoliotic deformity develops at 10 years of age. Such curves appear during the peripubertal period usually coinciding with the growth spurt. The screening test

(usually in 12-14 year olds) is to note the contour of the back on forward flexion (Fig 34.6).

normal abnormal

Fig. 34.6 Screening for adolescent idiopathic scoliosis: testing asymmetry by forward flexion The test

The subject stands with the feet parallel and together, and bends forward as far as possible with outstretched hands, palms facing each other, pointed between the great toes.

Investigation

A single erect PA spinal X-ray is sufficient; 5 the Cobb angle (Fig 34.7) is the usual measurement yardstick.

Lcp of ver leb-a at top end of curve

Lcp of ver leb-a at top end of curve

Cobb angle

Fig. 34.7 Scoliosis: the Cobb method of curve measurement

Cobb angle u J bottom of vertebra at lower end ûf curve

Fig. 34.7 Scoliosis: the Cobb method of curve measurement

Management

Aims

• to preserve good appearance—level shoulders and no trunk shift

• prevent increasing curve in adult life: less than 45°

• not to produce a straight spine on X-ray

Methods

• Braces: Milwaukee brace (rarely used) High density polyethylene underarm orthosis

To be worn for 20-22 hours each day until skeletal maturity is reached.

• Surgical correction: depends on curve and skeletal maturity

Guidelines for treatment

observe (repeat examination + X-ray)

observe, brace if progressive brace operate

• Growth complete:

<45° leave alone

Referral to consultant: >20°

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