Scoliosis Assessment and Diagnosis Quiz
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Questions and Answers

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?

  • Bend test
  • Spinal reflex test
  • Postural alignment test
  • Adam’s forward bend test (correct)

    • 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?

    <p>Birthmarks</p> Signup and view all the answers

    What is assessed to determine if the head is aligned above the sacrum during a truncal shift evaluation?

    <p>Trunk lateral deviation</p> Signup and view all the answers

    What is the required minimum degree of spinal curvature in the coronal plane for a diagnosis of scoliosis?

    <p>10°</p> Signup and view all the answers

    What percentage of cases with curves between 10° to 20° typically require surgery?

    <p>3%</p> Signup and view all the answers

    What is the most common type of curve seen in scoliosis cases?

    <p>Right thoracic curve</p> Signup and view all the answers

    In which group of family members is the risk of developing scoliosis highest?

    <p>First-degree relatives</p> Signup and view all the answers

    What is the typical unique aspect of each case of scoliosis?

    <p>Genetic background</p> Signup and view all the answers

    What is the genetic concordance rate for scoliosis in monozygotic twins?

    <p>73%</p> Signup and view all the answers

    What percentage of girls are affected by curves greater than 30° compared to boys?

    <p>10:1</p> Signup and view all the answers

    What must be ruled out when a left thoracic curve is detected in a patient?

    <p>Syrinx or cysts</p> Signup and view all the answers

    What condition is primarily associated with untreated progressive scoliosis that affects lung and heart function?

    <p>Cardiopulmonary failure</p> Signup and view all the answers

    What is the most common cause of congenital scoliosis?

    <p>Spontaneous occurrence</p> Signup and view all the answers

    What percentage of patients with associated conditions may experience cardiac defects in relation to congenital scoliosis?

    <p>20%</p> Signup and view all the answers

    Which imaging study is recommended to assess spinal cord abnormalities associated with congenital scoliosis?

    <p>MRI</p> Signup and view all the answers

    In cases of congenital scoliosis diagnosis, which syndrome should be investigated for associated symptoms?

    <p>VACTERL syndrome</p> Signup and view all the answers

    What type of curve is generally more resistant to conservative treatment in scoliosis?

    <p>Congenital curves</p> Signup and view all the answers

    What is the prevalence rate of scoliosis in the general population?

    <p>1–4%</p> Signup and view all the answers

    Which of the following options describes a potential physical appearance concern for scoliosis patients, especially females?

    <p>Cosmetic deformity</p> Signup and view all the answers

    What defines a block vertebra?

    <p>Complete attachment of vertebrae.</p> Signup and view all the answers

    What is the most severe combination of defects in spinal formation and segmentation?

    <p>Unilateral bar with hemivertebra.</p> Signup and view all the answers

    How are hemivertebra categorized?

    <p>Based on the degree and location of the defect.</p> Signup and view all the answers

    Which characteristic is associated with a block vertebra?

    <p>Reduced risk of progression.</p> Signup and view all the answers

    What embryonic structure serves as a framework for spinal development?

    <p>Notochord.</p> Signup and view all the answers

    Why is bracing usually not effective in treating certain spinal defects?

    <p>It fails to address the underlying defect.</p> Signup and view all the answers

    What is the least problematic type of vertebral defect?

    <p>Block vertebra.</p> Signup and view all the answers

    What indicates a positive Adam's test during the clinical assessment?

    <p>Observation of a rib hump</p> Signup and view all the answers

    Which diagnostic tool is primarily used to investigate associated pathologies in spinal defects?

    <p>Renal ultrasound.</p> Signup and view all the answers

    Which clinical sign may suggest the presence of spinal dysraphism?

    <p>Hairy patches on the midline</p> Signup and view all the answers

    What does an increased prominence of the right iliac crest indicate?

    <p>Asymmetrical pelvic tilt</p> Signup and view all the answers

    What condition is suggested by the presence of café-au-lait spots?

    <p>Neurofibromatosis</p> Signup and view all the answers

    When observing a patient for signs of truncal shift, what is essential to note?

    <p>Location of the head in relation to the sacrum</p> Signup and view all the answers

    What is the purpose of using a scoliometer during the assessment?

    <p>To assess the degree of spinal rotation</p> Signup and view all the answers

    In a clinical assessment, which condition does NOT correlate with uneven shoulder heights?

    <p>Leg length discrepancy</p> Signup and view all the answers

    What does a curve to the right indicate when observed on an X-ray during assessment?

    <p>Structural deformity in the spine</p> Signup and view all the answers

    What is the typical age of onset for Scheuermann's Kyphosis?

    <p>10-12 years</p> Signup and view all the answers

    What is the primary anatomical location affected by Scheuermann's Kyphosis?

    <p>Thoracic spine</p> Signup and view all the answers

    Which imaging technique is used to determine the rigidity of Scheuermann's Kyphosis?

    <p>Hyperextension lateral X-ray</p> Signup and view all the answers

    What Cobb angle measurement indicates normal kyphosis?

    <p>20 to 40 degrees</p> Signup and view all the answers

    What is a common non-surgical treatment for Scheuermann's Kyphosis?

    <p>Physiotherapy</p> Signup and view all the answers

    What indicates the need for surgical management in Scheuermann's Kyphosis?

    <p>Kyphosis angle greater than 70 degrees</p> Signup and view all the answers

    What is the male-to-female ratio typically observed in Scheuermann's Kyphosis?

    <p>2:1 to 7:1</p> Signup and view all the answers

    What symptom might present in extremly severe cases of Scheuermann's Kyphosis?

    <p>Severe pain</p> Signup and view all the answers

    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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    Scoliosis & Kyphosis PDF

    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.

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