Idiopathic scoliosis

Idiopathic scoliosis

Idiopathic scoliosis accounts for 70% of presentations. It can be classified into early onset (before 8 years of age) ( Figure 37.8 ) and late onset (after 8 years of age; typical adolescent idiopathic scoliosis). The distinction is important, as the number of alveoli in the lung does not increase after the age of 8 years. Patients with severe curves in the early-onset group may develop cor pulmonale and right ventricular failure resulting in premature death. Adolescent idiopathic scoliosis is associated with a normal or near-normal life expectancy . John R Cobb , American surgeon, wrote a paper in 1948 on how to measure the angle on a radiograph in scoliosis. Guillaume Benjamin Amand Duchenne , 1806–1875, neurologist, worked successively in Boulogne and Paris, France, but never held a hospital appointment. - The prevalence of curves with a Cobb angle >10° is between 0.5% and 3%. The prevalence of curves >30° is between 1.5 and 3 per 1000. Risk factors for progression include female gender, remaining skeletal growth, curve loca - tion and curve magnitude. Not all curves stabilise when skele - tal maturity is reached. In long-term studies, 68% experienced curve progression; the most marked progression of 1° per year was observed in patients with thoracic curves between 50° and /uni00A0 75°. Idiopathic curves of less than 25° ar e monitored with clinical and radiographic examination. In growing children (premenarchal) with curves between 20° and 29°, a brace may be indicated. Bracing is used to prevent curve progression and generally does not lead to permanent curve correction. Curves beyond 45° are not amenable to brace treatment. Surgery in the form of corrective instrumentation and spinal fusion is indicated for curve progression beyond 40°, truncal imbalance and unacceptable cosmesis. During sur - ger y , continuous spinal cord monitoring is used in the form of somatosensory evoked potentials (SSEPs), motor-evoked potentials (MEPs) and free-run and stimulated electromyo - graphic (EMG) activity to minimise the risk of neurological damage. The risk of neurological injury is 0.4% (1 in 250).

C1 C1 C2 C3 C2 C4 C3 C5 C4 C6 C5 C6 C7 C7 T1 T1 T2 T2 T3 T3 T4 T4 Figure 37.7 C7 closing wedge osteotomy for correction of cervicotho

racic kyphosis in patients with ankylosing spondylitis. Planned resec

tion lateral view (a) and lateral view after closure of the osteotomy (b) .

Idiopathic scoliosis

Idiopathic scoliosis accounts for 70% of presentations. It can be classified into early onset (before 8 years of age) ( Figure 37.8 ) and late onset (after 8 years of age; typical adolescent idiopathic scoliosis). The distinction is important, as the number of alveoli in the lung does not increase after the age of 8 years. Patients with severe curves in the early-onset group may develop cor pulmonale and right ventricular failure resulting in premature death. Adolescent idiopathic scoliosis is associated with a normal or near-normal life expectancy . John R Cobb , American surgeon, wrote a paper in 1948 on how to measure the angle on a radiograph in scoliosis. Guillaume Benjamin Amand Duchenne , 1806–1875, neurologist, worked successively in Boulogne and Paris, France, but never held a hospital appointment. - The prevalence of curves with a Cobb angle >10° is between 0.5% and 3%. The prevalence of curves >30° is between 1.5 and 3 per 1000. Risk factors for progression include female gender, remaining skeletal growth, curve loca - tion and curve magnitude. Not all curves stabilise when skele - tal maturity is reached. In long-term studies, 68% experienced curve progression; the most marked progression of 1° per year was observed in patients with thoracic curves between 50° and /uni00A0 75°. Idiopathic curves of less than 25° ar e monitored with clinical and radiographic examination. In growing children (premenarchal) with curves between 20° and 29°, a brace may be indicated. Bracing is used to prevent curve progression and generally does not lead to permanent curve correction. Curves beyond 45° are not amenable to brace treatment. Surgery in the form of corrective instrumentation and spinal fusion is indicated for curve progression beyond 40°, truncal imbalance and unacceptable cosmesis. During sur - ger y , continuous spinal cord monitoring is used in the form of somatosensory evoked potentials (SSEPs), motor-evoked potentials (MEPs) and free-run and stimulated electromyo - graphic (EMG) activity to minimise the risk of neurological damage. The risk of neurological injury is 0.4% (1 in 250).

C1 C1 C2 C3 C2 C4 C3 C5 C4 C6 C5 C6 C7 C7 T1 T1 T2 T2 T3 T3 T4 T4 Figure 37.7 C7 closing wedge osteotomy for correction of cervicotho

racic kyphosis in patients with ankylosing spondylitis. Planned resec

tion lateral view (a) and lateral view after closure of the osteotomy (b) .

Idiopathic scoliosis

Idiopathic scoliosis accounts for 70% of presentations. It can be classified into early onset (before 8 years of age) ( Figure 37.8 ) and late onset (after 8 years of age; typical adolescent idiopathic scoliosis). The distinction is important, as the number of alveoli in the lung does not increase after the age of 8 years. Patients with severe curves in the early-onset group may develop cor pulmonale and right ventricular failure resulting in premature death. Adolescent idiopathic scoliosis is associated with a normal or near-normal life expectancy . John R Cobb , American surgeon, wrote a paper in 1948 on how to measure the angle on a radiograph in scoliosis. Guillaume Benjamin Amand Duchenne , 1806–1875, neurologist, worked successively in Boulogne and Paris, France, but never held a hospital appointment. - The prevalence of curves with a Cobb angle >10° is between 0.5% and 3%. The prevalence of curves >30° is between 1.5 and 3 per 1000. Risk factors for progression include female gender, remaining skeletal growth, curve loca - tion and curve magnitude. Not all curves stabilise when skele - tal maturity is reached. In long-term studies, 68% experienced curve progression; the most marked progression of 1° per year was observed in patients with thoracic curves between 50° and /uni00A0 75°. Idiopathic curves of less than 25° ar e monitored with clinical and radiographic examination. In growing children (premenarchal) with curves between 20° and 29°, a brace may be indicated. Bracing is used to prevent curve progression and generally does not lead to permanent curve correction. Curves beyond 45° are not amenable to brace treatment. Surgery in the form of corrective instrumentation and spinal fusion is indicated for curve progression beyond 40°, truncal imbalance and unacceptable cosmesis. During sur - ger y , continuous spinal cord monitoring is used in the form of somatosensory evoked potentials (SSEPs), motor-evoked potentials (MEPs) and free-run and stimulated electromyo - graphic (EMG) activity to minimise the risk of neurological damage. The risk of neurological injury is 0.4% (1 in 250).

C1 C1 C2 C3 C2 C4 C3 C5 C4 C6 C5 C6 C7 C7 T1 T1 T2 T2 T3 T3 T4 T4 Figure 37.7 C7 closing wedge osteotomy for correction of cervicotho

racic kyphosis in patients with ankylosing spondylitis. Planned resec

tion lateral view (a) and lateral view after closure of the osteotomy (b) .