Scoliosis

Scoliosis

The term ‘scoliosis’ describes spinal deformity in three planes: lateral curvature is the most obvious deformity while the rota tional component is most apparent in forward flexion when the rib asymmetry creates a ‘rib hump’ ( Figure 44.35 ). The cause may be idiopathic, neuromuscular, related to a syndrome or congenital. Both the aetiology and the age of onset a ff ect the natural history ( Table 44.12 ). In general, the earlier the onset, the more likely the deformity is to be progressive. As most lung development occurs in early childhood, the management of early-onset scoliosis must preserve growth: casting techniques or the use of ‘growing rods’ may be appropriate. The adolescent idiopathic curve is the most common, a ff ecting girls more than boys. Idiopathic scoliosis is generally not painful and, therefore, in the presence of significant pain tumour and infection must be excluded. The Cobb angle is a radiological measurement that defines se verity and guides treatment ( Figure 44.36 ). Curves <20° do not need treatment, progressive curves of 25–40° may be braced and those >40° are considered for surgery , which involves instrumenting and fusing the spine (see also Chapter 37 ).

TABLE 44.12 Classi /f_i cation of idiopathic scoliosis. Type Age at onset Early onset <10 years Adolescent 11–18 years Adult Onset at maturity

Scoliosis

The term ‘scoliosis’ describes spinal deformity in three planes: lateral curvature is the most obvious deformity while the rota tional component is most apparent in forward flexion when the rib asymmetry creates a ‘rib hump’ ( Figure 44.35 ). The cause may be idiopathic, neuromuscular, related to a syndrome or congenital. Both the aetiology and the age of onset a ff ect the natural history ( Table 44.12 ). In general, the earlier the onset, the more likely the deformity is to be progressive. As most lung development occurs in early childhood, the management of early-onset scoliosis must preserve growth: casting techniques or the use of ‘growing rods’ may be appropriate. The adolescent idiopathic curve is the most common, a ff ecting girls more than boys. Idiopathic scoliosis is generally not painful and, therefore, in the presence of significant pain tumour and infection must be excluded. The Cobb angle is a radiological measurement that defines se verity and guides treatment ( Figure 44.36 ). Curves <20° do not need treatment, progressive curves of 25–40° may be braced and those >40° are considered for surgery , which involves instrumenting and fusing the spine (see also Chapter 37 ).

TABLE 44.12 Classi /f_i cation of idiopathic scoliosis. Type Age at onset Early onset <10 years Adolescent 11–18 years Adult Onset at maturity

Scoliosis

The term ‘scoliosis’ describes spinal deformity in three planes: lateral curvature is the most obvious deformity while the rota tional component is most apparent in forward flexion when the rib asymmetry creates a ‘rib hump’ ( Figure 44.35 ). The cause may be idiopathic, neuromuscular, related to a syndrome or congenital. Both the aetiology and the age of onset a ff ect the natural history ( Table 44.12 ). In general, the earlier the onset, the more likely the deformity is to be progressive. As most lung development occurs in early childhood, the management of early-onset scoliosis must preserve growth: casting techniques or the use of ‘growing rods’ may be appropriate. The adolescent idiopathic curve is the most common, a ff ecting girls more than boys. Idiopathic scoliosis is generally not painful and, therefore, in the presence of significant pain tumour and infection must be excluded. The Cobb angle is a radiological measurement that defines se verity and guides treatment ( Figure 44.36 ). Curves <20° do not need treatment, progressive curves of 25–40° may be braced and those >40° are considered for surgery , which involves instrumenting and fusing the spine (see also Chapter 37 ).

TABLE 44.12 Classi /f_i cation of idiopathic scoliosis. Type Age at onset Early onset <10 years Adolescent 11–18 years Adult Onset at maturity