SCOLIOSIS

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Last Updated : 12/30/2010
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Ashok Johari
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Common scoliosis
75% of the scoliosis are idiopathic. Idiopathic scoliosis is one where the etiology is unknown, but, it is probably genetic and the mode of inheritance is complex. Routine evaluation of school children aged 10-14 years has shown an incidence of up to 12%. Smaller curves (up to 15 degrees) and at a younger age, the incidence is equal in males and females. Beyond the age of 10-11 years 80% of the significant curves are in females.

Idiopathic Infantile Scoliosis
It represents 1% of the scoliosis. It is not associated with vertebral anomalies. Curves less than 37 degrees resolve spontaneously. Curves more than 37 degrees are known to progress and are often associated with plagiocephaly. These curves are treated by succession of plaster jackets till 3 years of age when a Milwaukee brace can be fitted. If curves are progressive inspite of bracing treatment in the form of fusion is performed.

Idiopathic Juvenile Scoliosis
This represents 10% of scoliosis cases. It is more common in girls and right-sided curves are common. Treatment is required in curves of more than 25-30 degrees.

Idiopathic Adolescent scoliosis
This is commonest type of idiopathic scoliosis. 80% of the patients are females. The presentation is usually subtle and is unnoticed for a long time. Asymmetry of the shoulders, poor fitting of clothes, a rib hump, a prominent shoulder blade draw the attention of the parents. Severe untreated scoliosis produces physiologic cardiopulmonary impairment and unacceptable cosmetic appearance. The natural history varies with the severity of scoliosis. Curves more than 30 degrees progress. Progression occurs commonly during the growth spurt. Curves greater than 50-60 degrees are known to progress even after maturity.

Mild curves (less than 20 degrees) need to be observed for progression. Moderate curves are treated by bracing, the objectives of treatment are :
- To have a stable and balanced, cosmetically acceptable curve till the patient achieves skeletal maturity.
- Avoid over-treatment of the non-progressive curves.
- Avoid iatrogenic loss of lumbar flexibility.

Curves more than 45 degrees cannot be treated by bracing and have to be treated by surgery.

The principle of surgery is to correct the deformity till the spine is compensated and then fusion of the spine. Instrumentation( e.g. Harrington rod) is used to achieve correction and maintain it till fusion occurs . If instrumentation is used in children with a major growth spurt remaining, the patient may require a staged surgical correction.





Pre-surgery patient





Post-surgery patient





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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