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Idiopathic Scoliosis

Idiopathic scoliosis is the most common type of structural spinal deformity during childhood. This type of scoliosis has a genetic predisposition, and although, many etiologic theories have been proposed, the causer unknown.

Idiopathic scoliosis is subclassified into three groups by age of onset: infantile (birth to 3 years of age), juvenile (3 to 10 years of age), and adolescent (older than 10 years of age but before maturity). Infantile idiopathic scoliosis accounts for less than 1% of all cases of idiopathic scoliosis in the Europe. The infantile form affects more males than females and has associated characteristics such as plagiocephaly, congenital heart disease, developmental dysplasia of the hip, and mental retardation. Another distinguishing feature of infantile idiopathic scoliosis is the clinical course, which usually involves either spontaneous resolution or significant progression. Patients classified as having juvenile idiopathic scoliosis may actually have late-onset infantile idiopathic scoliosis or early-onset adolescent idiopathic scoliosis. This group of patients accounts for about 20% of all idiopathic patients and occurs more commonly in girls. Most curves are right thoracic followed by double major curves (right thoracic and left lumbar) and thoracolumbar curves.

Adolescent idiopathic scoliosis accounts for approximately 80% of cases of idiopathic scoliosis. The prevalence of adolescent idiopathic scoliosis in the general population is about 2 to 3%, but as curve magnitude increases, the overall prevalence of this condition decreases to 0.1% (Cobb angle > 40 degrees). Although there is an overall female predominance in this condition, curves of small magnitude are equally prevalent in both sexes. Despite the large number of cases of adolescent idiopathic scoliosis diagnosed through school screening, less than 10% of the positively screened patients require active treatment.

Treatment Guidelines

Most patients with an established diagnosis of idiopathic scoliosis do not require treatment. Of patients identified through school screening, only 7% of those with spinal asymmetry on Adams bending test will require treatment.

During the past several decades, a large variety of orthotic devices have been developed for the treatment of scoliosis. The goal of bracing programs is to contain the curve rather than to exact improvement. Patients should be skeletally immature (Risser 0, 1, or 2), have a curve in the range of 20 to 40 degrees, have a deformity that they consider cosmetically acceptable, and be willing to accept brace treatment. Those patients with curves between 20 and 30 degrees can be observed. If curve progression of 5 degrees or more occurs, brace treatment should be initiated. Because bracing is effective in managing smaller curves, some authors advocate initiating treatment for curves of 25 degrees or more, when the Risser is 0. The use of bracing in more mature patients (Risser 3 and 4) should be individualized for each patient. Most studies demonstrate that bracing is ineffective in curves greater than 45 degrees.

The type of curve pattern is also an important determinant for bracing. Most authors believe that curves with the apex at or above the T7 vertebra are not amenable to braces without a cervical extension. Double curves may not be amenable to bracing because maximal correction of one curve may decrease the correction of the adjacent curve.

The indications for surgical intervention are based upon characteristics of the curve and of the patient. Curve factors include location, magnitude, rotation, progression, and balance. The patient's age is of primary importance. In general terms, a skeletally immature patient who presents with a curve beyond the limits of effective brace treatment (40 to 45 degrees) or who demonstrates progression is a candidate for fusion. Mature patients with thoracic curves greater than 50 degrees and thoracolumbar or lumbar curves greater than 30 degrees with marked apical rotation or translatory shift may also be considered surgical candidates.

Surgical treatment involves a posterior spinal fusion in combination with one of the various forms of spinal instrumentation. The purpose of the procedure is to obtain a solid spinal fusion and to have the top and the bottom of the fusion balanced.

Example

•Gender: Female
•Age: 29
•Symptom Description: King IV type, scoliosis 105° , correction result in near-normal appearance.


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