Idiopathic scoliosis

Abstract

Background: Scoliosis is a three-dimensional deviation of the spinal axis. The main diagnostic criterion is spinal curvature exceeding 10° on a plain anteroposterior X-ray image. Scoliosis is called idiopathic when no other underlying disease can be identified.

Methods: Selective literature review and recommendations of the relevant medical societies in Germany and abroad.

Results: Scoliosis in children of school age and above primarily occurs in girls. Its prevalence is 1% to 2% among adolescents, but more than 50% among persons over age 60. The therapeutic goal in children is to prevent progression. In children, scoliosis of 20° or more should be treated with a brace, and scoliosis of 45° or more with surgery. The treatment of adults with scoliosis is determined on an individual basis, with physiotherapy and braces playing a relatively minor role. Adults (even elderly adults) who have scoliosis and sagittal imbalance may be best served by surgical treatment.

Conclusion: Scoliosis is common. Early diagnosis makes a major difference in the choice of treatment.

Figure 1

X-rays of a 14-year-old girl with a 90° scoliosis that was nearly fully corrected through dorsal surgery with stabilization; a) preoperative posteroanterior view with the Cobb angle indicated; b) preoperative lateral view; c) postoperative posteroanterior view with the Cobb angle indicated with the aid of radio-opaque markers; d) postoperative lateral view

Figure 2

The Adams forward-bending test in a 15-year-old girl with right-convex adolescent idiopathic thoracic scoliosis; a) when the patient stands upright, mild asymmetry at the waist and a mild shoulder tilt are noted; b) when she bends forward, spinal rotation becomes evident through the appearance of a hunched rib cage on the right

Figure 3

X-ray of a 3-year-old boy with infantile 90° scoliosis. The scoliosis was reduced to 55° with the implantation and distraction of a Vertical Expandable Prostethic Titanium Rib (VEPTR). Further distractions are now being performed manually in approximately 6-month intervals

Figure 4

X-ray of an 8-year-old girl a) with lumbar 45° scoliosis: b) stapling not only stabilized the scoliosis, but almost completely corrected it as well. Because the patient was so young, progressive scoliosis would have been a near certainty without surgery

eFigure 1

X-ray images: a) Risser stages; b) not yet ossified triradiate cartilage; c) centers of ossification in the hand

eFigure 2

X-ray of a 78-year-old woman with progressive scoliosis, which is probably due to a combination of initial adolescent scoliosis with degenerative changes that arose later on in life. She had undergone surgical stabilization of the cervical spine a few years previously because of degenerative changes; this indicates the patient’s general propensity to develop spinal degenerative disease. Steadily worsening lumbar spinal nerve compression caused immobilizing pain that failed to respond to conservative measures. A nerve-decompression procedure alone would probably have yielded only temporary relief because of the likely continued progression of scoliosis. Instead, she underwent decompression of the lumbar spinal canal and neural foramina combined with stabilization of a long segment of the spine. Despite her advanced age, the operation markedly improved her quality of life. a, b, preoperative images; c, d, postoperative images