Type of Scoliosis | |||||
Numbers | Prevalence 1% to 4% | Present in 25 and 90% of neuromuscular disease | ㅤ | Most common type Incidence: 3% 10-20°, 0.3% > 30° | ㅤ |
Aetiology | Defects occur at weeks 4-6 of the embryonic period. | Neuro (Upper/lower motor neuron/mixed)Muscular cause (Mytotonic dystrophy, muscular dystrophies, congenitial hypotonia) | Unknown cause; | ㅤ | Degeneration Iatrogenic metabolic (osteoporosis) Idiopathic (Adult that were AIS) |
Age of Onset | Typically diagnosed the youngest age than idiopathic scoliosis | Can develop at a younger age than idiopathic scoliosis | IIS < 3 JIS 4-10 | >10 | Usually occurs in older adults (50+ years) |
Gender | ㅤ | ㅤ | IIS: Male Left curve JIS: Female Right curve | Female Right curve | ㅤ |
Location curve | Lower thoracic or TL J(x) | TL Jx/Lumbar | Thoracic spineRight sided curve more | ㅤ | Lumbar spine |
Curve size | Larger | Larger | Larger | Larger | Smaller |
Subtypes | McMaster and Ohtsuka aetiological classification (as above) | as per aetiology | Infantile Idiopathic scoliosis (IIS)Juvenile Idiopathic scoliosis (JIS) | Adolescent Idiopathic scoliosis | Type 1 (degen), 2 (AIS in adult), 3 (2ndary adult scoliosis) |
Classification | Desegmentation deficit (Block vertebrae/Bar body)Malformation deficit (Hemivertebrae (unsegmented /semisegmented/fully segmented/ incarcerated/unincacerated)vs wedge) Mixed | ㅤ | ㅤ | Lenke | ㅤ |
Spinal Curvature Pattern | May involve sideways curvature and extra curves in the opposite direction (myopathic scoliosis) | Long, sweeping S- or C-shaped curves involving the entire spine, including the sacrum | Coronal plane curvature; Cobb angle measurement | ㅤ | Often manifests as lateral curvature with rotation (C-shaped or S-shaped) |
Natural progression | 50% progress significantly 25% do not progress25% progress slightlyBar body: 5 deg/yrWedge vertebrae/fully segmented: 2 deg/yr Others less likely to progress | Amost all will progress | Early onset IS: 90% of cases will resolve spontaneously. RVAD angle < 20°, 85– 90% curve will spontaenously resolve | Late onset IS: depends on age Double > single curves: progress more than single curves. | Curves < 30° generally do not progress, curves 30-50° progress 10-15° during life, curves 50-75° progress at 1° per year. |
Tx treshold | Progressive curves with > one hemivertebra, a unilateral bar, or a mixed defect, as these are the curves which tend to progress. | Duchenne’s muscular dystrophy (when curves reach 20°)> 40 deg (no need to delay surgery until skeletal maturity | >50 | >40 deg if skeletal mature and fail brace | > 50 degrees |
General
- A lateral curvature of the spine of > 10°, often with a rotational component.
- A common
- Relatively slowly evolving condition.
- Exception: some neuromuscular conditions
- Young patients with scoliosis tend to be active and mobile.
Clinical presentation
Children
- Cosmetic problem
- Respiratory problems
Adults
- Axial spinal pain
- Radicular symptoms
Classification of scoliosis in children
- Scoliosis in children may be classified by age of onset, by aetiology, or a combination of both.
Age
- New: Depending on lung development.
- Early onset scoliosis (0– 9 years)
- Early onset scoliosis can lead to thoracic insufficiency syndrome.
- Due to:
- limiting the height of the thoracic spine OR because the apex of the curve rotates into the chest on the convex side, encroaching on the space available for the lung OR Rib anomalies → restricted lung growth → leading to the inability of the chest to support normal breathing.
- (18– 22 cm of height from T1 to T12 is required for normal lung function)
- Late onset scoliosis’ (10– 18 years)
- At the age of 10, the thoracic volume is 50% of its final size.
- A ‘late onset’ scoliosis is unlikely to cause any change in lung function unless the curve becomes very large (>90 degrees).
- Old
- Idiopathic scoliosis age onset classification
- Infantile (0–3 years)
- Juvenile (4– 9 years)
- Adolescent (10– 18 years)
Aetiology
- Idiopathic (70%)
- Paediatric
- Adult
- Congenital (15%)
- Neuromuscular (10%)
- Syndromic
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