Podcast
Questions and Answers
What is the purpose of observing shoulder height during the postural assessment?
What is the purpose of observing shoulder height during the postural assessment?
- To assess for rib rotational deformity
- To determine if one shoulder is higher than the other (correct)
- To identify potential neurological issues
- To check for spinal alignment
Which test is specifically mentioned for identifying rib rotational deformity?
Which test is specifically mentioned for identifying rib rotational deformity?
- Bend test
- Spinal reflex test
- Postural alignment test
- Adam’s forward bend test (correct)
What does an asymmetric abdominal reflex test potentially indicate?
What does an asymmetric abdominal reflex test potentially indicate?
- Scoliosis adaptation
- Congenital deformity
- Normal development
- Pathological condition (correct)
Which skin defect is not associated with spinal dysraphism?
Which skin defect is not associated with spinal dysraphism?
What is assessed to determine if the head is aligned above the sacrum during a truncal shift evaluation?
What is assessed to determine if the head is aligned above the sacrum during a truncal shift evaluation?
What is the required minimum degree of spinal curvature in the coronal plane for a diagnosis of scoliosis?
What is the required minimum degree of spinal curvature in the coronal plane for a diagnosis of scoliosis?
What percentage of cases with curves between 10° to 20° typically require surgery?
What percentage of cases with curves between 10° to 20° typically require surgery?
What is the most common type of curve seen in scoliosis cases?
What is the most common type of curve seen in scoliosis cases?
In which group of family members is the risk of developing scoliosis highest?
In which group of family members is the risk of developing scoliosis highest?
What is the typical unique aspect of each case of scoliosis?
What is the typical unique aspect of each case of scoliosis?
What is the genetic concordance rate for scoliosis in monozygotic twins?
What is the genetic concordance rate for scoliosis in monozygotic twins?
What percentage of girls are affected by curves greater than 30° compared to boys?
What percentage of girls are affected by curves greater than 30° compared to boys?
What must be ruled out when a left thoracic curve is detected in a patient?
What must be ruled out when a left thoracic curve is detected in a patient?
What condition is primarily associated with untreated progressive scoliosis that affects lung and heart function?
What condition is primarily associated with untreated progressive scoliosis that affects lung and heart function?
What is the most common cause of congenital scoliosis?
What is the most common cause of congenital scoliosis?
What percentage of patients with associated conditions may experience cardiac defects in relation to congenital scoliosis?
What percentage of patients with associated conditions may experience cardiac defects in relation to congenital scoliosis?
Which imaging study is recommended to assess spinal cord abnormalities associated with congenital scoliosis?
Which imaging study is recommended to assess spinal cord abnormalities associated with congenital scoliosis?
In cases of congenital scoliosis diagnosis, which syndrome should be investigated for associated symptoms?
In cases of congenital scoliosis diagnosis, which syndrome should be investigated for associated symptoms?
What type of curve is generally more resistant to conservative treatment in scoliosis?
What type of curve is generally more resistant to conservative treatment in scoliosis?
What is the prevalence rate of scoliosis in the general population?
What is the prevalence rate of scoliosis in the general population?
Which of the following options describes a potential physical appearance concern for scoliosis patients, especially females?
Which of the following options describes a potential physical appearance concern for scoliosis patients, especially females?
What defines a block vertebra?
What defines a block vertebra?
What is the most severe combination of defects in spinal formation and segmentation?
What is the most severe combination of defects in spinal formation and segmentation?
How are hemivertebra categorized?
How are hemivertebra categorized?
Which characteristic is associated with a block vertebra?
Which characteristic is associated with a block vertebra?
What embryonic structure serves as a framework for spinal development?
What embryonic structure serves as a framework for spinal development?
Why is bracing usually not effective in treating certain spinal defects?
Why is bracing usually not effective in treating certain spinal defects?
What is the least problematic type of vertebral defect?
What is the least problematic type of vertebral defect?
What indicates a positive Adam's test during the clinical assessment?
What indicates a positive Adam's test during the clinical assessment?
Which diagnostic tool is primarily used to investigate associated pathologies in spinal defects?
Which diagnostic tool is primarily used to investigate associated pathologies in spinal defects?
Which clinical sign may suggest the presence of spinal dysraphism?
Which clinical sign may suggest the presence of spinal dysraphism?
What does an increased prominence of the right iliac crest indicate?
What does an increased prominence of the right iliac crest indicate?
What condition is suggested by the presence of café-au-lait spots?
What condition is suggested by the presence of café-au-lait spots?
When observing a patient for signs of truncal shift, what is essential to note?
When observing a patient for signs of truncal shift, what is essential to note?
What is the purpose of using a scoliometer during the assessment?
What is the purpose of using a scoliometer during the assessment?
In a clinical assessment, which condition does NOT correlate with uneven shoulder heights?
In a clinical assessment, which condition does NOT correlate with uneven shoulder heights?
What does a curve to the right indicate when observed on an X-ray during assessment?
What does a curve to the right indicate when observed on an X-ray during assessment?
What is the typical age of onset for Scheuermann's Kyphosis?
What is the typical age of onset for Scheuermann's Kyphosis?
What is the primary anatomical location affected by Scheuermann's Kyphosis?
What is the primary anatomical location affected by Scheuermann's Kyphosis?
Which imaging technique is used to determine the rigidity of Scheuermann's Kyphosis?
Which imaging technique is used to determine the rigidity of Scheuermann's Kyphosis?
What Cobb angle measurement indicates normal kyphosis?
What Cobb angle measurement indicates normal kyphosis?
What is a common non-surgical treatment for Scheuermann's Kyphosis?
What is a common non-surgical treatment for Scheuermann's Kyphosis?
What indicates the need for surgical management in Scheuermann's Kyphosis?
What indicates the need for surgical management in Scheuermann's Kyphosis?
What is the male-to-female ratio typically observed in Scheuermann's Kyphosis?
What is the male-to-female ratio typically observed in Scheuermann's Kyphosis?
What symptom might present in extremly severe cases of Scheuermann's Kyphosis?
What symptom might present in extremly severe cases of Scheuermann's Kyphosis?
Flashcards
Truncal Shift
Truncal Shift
A visible shift in the body's alignment where the head is not directly over the sacrum, indicating a potential scoliosis.
Shoulder Height Asymmetry
Shoulder Height Asymmetry
The difference in height between the two shoulders, a potential sign of scoliosis.
Adam's Forward Bend Test
Adam's Forward Bend Test
A test used to evaluate scoliosis by examining the patient's rib cage appearance while bending forward. It can help identify rotational deformities in the ribs, common in scoliosis.
Spinal Dysraphism
Spinal Dysraphism
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Abdominal Reflex
Abdominal Reflex
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What is scoliosis?
What is scoliosis?
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What is the cause of scoliosis?
What is the cause of scoliosis?
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Is scoliosis hereditary?
Is scoliosis hereditary?
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What determines the progression of scoliosis?
What determines the progression of scoliosis?
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Does every case of scoliosis need surgery?
Does every case of scoliosis need surgery?
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What kind of scoliosis curves are most common?
What kind of scoliosis curves are most common?
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Why is early detection of scoliosis important?
Why is early detection of scoliosis important?
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What is the most important thing to prevent during scoliosis surgery?
What is the most important thing to prevent during scoliosis surgery?
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Scoliosis
Scoliosis
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Scoliometer
Scoliometer
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Rib Rotational Deformity
Rib Rotational Deformity
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Leg Length Inequality
Leg Length Inequality
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Congenital Scoliosis
Congenital Scoliosis
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Associated Conditions with Congenital Scoliosis
Associated Conditions with Congenital Scoliosis
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Severity of Congenital Scoliosis
Severity of Congenital Scoliosis
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Location of Curve in Congenital Scoliosis
Location of Curve in Congenital Scoliosis
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Types of Congenital Scoliosis
Types of Congenital Scoliosis
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Progression of Congenital Scoliosis
Progression of Congenital Scoliosis
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Treatment Options for Congenital Scoliosis
Treatment Options for Congenital Scoliosis
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Individualized Treatment for Congenital Scoliosis
Individualized Treatment for Congenital Scoliosis
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Block Vertebra
Block Vertebra
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Bar (Vertebra)
Bar (Vertebra)
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Hemivertebra
Hemivertebra
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Unilateral Bar with Hemivertebra
Unilateral Bar with Hemivertebra
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Notochord's Role in Spine Development
Notochord's Role in Spine Development
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Somite Segmentation and Spine
Somite Segmentation and Spine
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Somite Segmentation Defects and Scoliosis
Somite Segmentation Defects and Scoliosis
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Investigation for Spinal Deformities
Investigation for Spinal Deformities
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What is Scheuermann's Kyphosis?
What is Scheuermann's Kyphosis?
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How common is Scheuermann's Kyphosis?
How common is Scheuermann's Kyphosis?
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Who is more likely to have Scheuermann's Kyphosis?
Who is more likely to have Scheuermann's Kyphosis?
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Where does Scheuermann's Kyphosis usually occur?
Where does Scheuermann's Kyphosis usually occur?
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How is Scheuermann's Kyphosis diagnosed?
How is Scheuermann's Kyphosis diagnosed?
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What is a normal Cobb angle for kyphosis?
What is a normal Cobb angle for kyphosis?
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What are common presentations of Scheuermann's Kyphosis?
What are common presentations of Scheuermann's Kyphosis?
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How is Scheuermann's Kyphosis treated?
How is Scheuermann's Kyphosis treated?
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Study Notes
Scoliosis
- Spinal curvature in the coronal plane of >10°
- Scoliosis is a three-dimensional deformity: coronal, sagittal, and axial (rotation) planes.
- The spine is a fixed structure at both the superior and inferior ends.
- If one side of the spine grows faster, it will begin to bend
- The faster-growing side causes a lateral bend, creating coronal curvature.
- If the anterior column grows faster than the posterior column, it results in lordosis.
- The spine may start to rotate, leading to a twisting deformity.
- The ribs may also rotate with the spine.
Types of Scoliosis
- Idiopathic (unknown cause)
- Congenital
- Developmental or Syndromic
- Neuromuscular
- Pathologic or neoplastic (can occur, especially in infants who undergo cardiac surgery)
Classification of Scoliosis
- By age: Infantile (0-3 years), Juvenile (4-10 years), Adolescent (11-17 years), Adult (>18 years)
- By etiology: Idiopathic, Neuromuscular, Syndrome related, Congenital
- Early onset scoliosis (2014): Scoliosis with onset less than 10 years of age, regardless of etiology. Developed by SRS in 2014.
Goals of Treatment
- Prevent progression (primary goal)
- Correct deformity (not caused by spinal cord injury)
Adolescent Idiopathic Scoliosis
- Spinal curvature in the coronal plane of >10°
- Diagnosis of exclusion (no syndromic, congenital, or neuromuscular causes)
- Incidence: 3% for curves between 10 to 20°, 0.3% for curves >30°
- 10:1 female-to-male ratio for curves >30°
- Right thoracic curve is the most common type. A left thoracic curve may indicate a need for MRI to rule out cyst or syrinx.)
Etiology of Scoliosis
- Multifactorial with genetic predisposing factors
- Often seen in multiple members of a family
- Concordance in 73% of monozygotic twins and 36% of dizygotic twins
- 11% risk to first-degree relatives, 2.4% risk to second-degree relatives, and 1.4% to third-degree relatives
Pathogenesis of Scoliosis
- Abnormal development of neurocentral synchondrosis (NCS)
- Cartilaginous plate forms between centrum and posterior neural arches
- Closure occurs in a characteristic order: cervical NCS by 5-6 years old, lumbar NCS by 11-12 years old, thoracic NCS by 14-17 years old
Primary and Secondary Ossification Centers
- Primary ossification centers: initial sites of cartilage formation, which transforms into bone, beginning early in fetal development.
- Secondary ossification centers: arise later in life, mainly after birth. They aid in bone development in certain body parts including vertebrae and other bones.
Clinical Assessment
- History (Hx)
- School screenings, parent/patient notice of a change in appearance, or incidental observation
- History of present illness (HPI)
- Onset
- Progression
- Pain
- Bowel and bladder function
- Physical activity
- Patient expectations
- Family history (PMH, PSH, Allergy)
- Diagnosis
- Is the condition idiopathic, syndromic, congenital, neurological?, etc.
- Any family history
- Any unusual birth complications
- Assessing progression
- Growth potential
- Menarche/puberty
- Observing asymmetry or deviations (e.g., hip height difference, Umbilicus)
Radiological Assessment
- X-ray (long film PA/Lat): Used to assess the degree and severity of scoliosis. PA views are preferred to reduce radiation exposure.
- Bone maturity: assessment of bone growth and development. Useful for predicting progression of scoliosis
- MRI
- Cobb angle measurements: A technique used in X-rays to determine the severity of curvature of the spine.
- Left thoracic scoliosis or unilateral bar with hemivertebra, may require MRI to rule out potential issues
Indications for MRI
- Early age at onset
- Rapid progression
- Left-sided curve (common), severe curve (right or left)
- Back pain
- Weakness or spasticity
- Neurologic symptoms
- Asymmetric reflexes
- Cutaneous lesions
- Cavovarus feet
Bone Maturity Assessment
- Tanner staging
- Left hand X-ray
- Sander
- Risser score (pelvis X-ray)
- Menarchal status
- Shaving status
Treatment
- Observation for curves less than 25° or with skeletally immature patients.
- Brace for curves between 25° and 45° (significant growth remaining, 12-18 hrs/day).
- Surgical treatment for curves greater than 50°
- Surgical treatment for block vertebrae or hemivertebra
Untreated Progressive Scoliosis
- Cardiopulmonary failure
- Degenerative changes of the spine
- Pain
- Cosmetic deformity
- Spinal imbalance
Congenital Scoliosis
- Prevalence (1–4%)
- Curve has a sharper angle over a shorter segment, and more resistance to conservative treatment than idiopathic curves
- Causes
- Spontaneous
- In-utero exposure (alcohol, valproate, diabetes)
- Genetic
Associated Conditions
- Cardiac defects (20%)
- Genitourinary defects (20%)
- Spinal cord malformations (21-37%) (diastematomyelia, tethered cord)
- VACTERL syndrome
- Vertebral/Anal atresia/Cardiac/TracheoEsophageal/Renal/Limb abnormalities
- Klippel-Feil syndrome
- Alagille syndrome
Pathogenesis (Defects of Segmentation/Formation)
- Segmentation defects (block vertebra, bar)
- Formation defects (hemivertebra)
- Combined defects
Investigation
- To rule out associated pathology
- Renal US
- Echo (Cardiac)
- Radiological assessment
- X-ray
- CT
- MRI
Kyphosis
- Kyphosis is a spinal 1-plane deformity noted on the sagittal view
- A normal thoracic kyphosis measures 20-40 degrees (can reach 60)
- Measured by the Cobb angle in the lateral view
Causes of Kyphosis
- Scheuermann's kyphosis
- Postural round back
- Congenital kyphosis
- Syndromic spine deformity
Scheuermann's Kyphosis
- Definition: rigid kyphosis with anterior wedging of >5° across three or more consecutive vertebrae, typically in the thoracic spine
- Incidence: 0.4-8.3%, most common in adolescents, typical onset 10-12 years
Diagnosis of Scheuermann's Kyphosis
- Standard lateral X-ray
- Hyperextension lateral X-ray (to assess rigidity)
- Cobb angle measurement (20-40° normal)
Treatment of Scheuermann's Kyphosis
- Observation and physical therapy
- Surgical management indicated with a kyphosis severity >70° and if there are progressive neurological deficits or pain.
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Description
Test your knowledge on the assessment and diagnosis of scoliosis. This quiz covers various aspects including postural assessment, spinal curvature degrees, and genetic factors related to scoliosis. Challenge yourself with questions about clinical signs and measurement techniques associated with this condition.
