SCOLIOSIS

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Last Updated : 12/30/2010
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Ashok Johari
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What are types of scoliosis ?
The various types of scoliosis are:
Postural scoliosis: It is not accompanied by rotational deformity and is fully correctable on lateral bending and recumbency.
Functional scoliosis: It results form leg length discrepancy and has a convexity towards the depressed side of the pelvis. It resolves on correction of the limb length.
Structural scoliosis: It is not fully correctable on lateral bending or traction. It is of various types:
- Idiopathic the commonest type. According to the age of onset:
*Infantile - before the age of 3 years.
*Juvenile - between the age of 3 and 10 years.
*Adolescent - after the age of 10 years.
- Congenital - It results from defective unilateral segmentation or formation. This is often associated with absence or fusion of ribs.
- Neuromuscular which may be
*Neurological e.g. Polio, Cerebral Palsy
*Myogenic e.g. myopathy, muscular dystrophy
- Neurofibromatosis
- Mesenchymal disorders e.g. Arthrogryposis, Morquio's Syndrome, Marfan's Syndrome.
- Traumatic

Congenital scoliosis
Congenital Scoliosis results from defective unilateral segmentation or formation. This is often associated with absence or fusion of ribs. Associated anomalies may be present in the form of a 20% incidence of genito-urinary anomalies and 7% incidence of congenital heart disease. Diastematomyelia occurs in 5% of the cases.
Congenital scoliosis are classified by MacEwen as :
Failure of formation
- Partial failure of formation - wedge vertebrae.
- Complete failure of formation - hemivertebrae.
Failure of segmentation
- Unilateral failure of segmentation - unilateral unsegmented bar.
- Bilateral failure of segmentation - block vertebrae.
Miscellaneous
Unsegmented bar and multiple hemivertebrae adjacent to one another on the same side are responsible for the progressive curves. The greater the curves in terms of degrees and longer the curve in terms of number of vertebral segments involved, the more likely the curve will progress.

Treatment consists of
- Non-operative treatment: Bracing (e.g. Milwaukee brace) is effective. It is primarily used for the more flexible secondary curves below the congenital one. If the brace maintains the curve in an acceptable position, it is continued. If the curve deteriorates despite faithful brace wearing, fusion is indicated. Bracing is not effective in curves exceeding 50 degrees.
- Operative treatment: A progressive curve must be treated surgically at a very young age. The various options are:
* Fusion in situ
* Cast / halo pelvic correction with fusion
* Epiphysiodesis to prevent growth on the convex side with fusion.

References

Contributor Information and Disclosures Ashok Johari
Consulting Pediatric Orthopedic, Bombay Hospital, B.J.Wadia Children's Hospital, Children's Orthopedic Centre, Mumbai, India


First Created : 2/20/2001
References
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