Scoliosis: Review of diagnosis and treatment

Abstract

Scoliosis is a spinal deformity consisting of lateral curvature and rotation of the vertebrae. The causes of scoliosis vary and are classified broadly as congenital, neuromuscular, syndrome-related, idiopathic and spinal curvature due to secondary reasons. The majority of scoliosis cases encountered by the general practitioner will be idiopathic. The natural history relates to the etiology and age at presentation, and usually dictates the treatment. However, it is the patient's history, physical examination and radiographs that are critical in the initial evaluation of scoliosis, and in determining which patients need additional considerations. Scoliosis with a primary diagnosis (nonidiopathic) must be recognized by the physician to identify the causes, which may require intervention. Patients with congenital scoliosis must be evaluated for cardiac and renal abnormalities. School screening for scoliosis is controversial and is falling out of favour. The treatment for idiopathic scoliosis is based on age, curve magnitude and risk of progression, and includes observation, orthotic management and surgical correction with fusion. A child should be referred to a specialist if the curve is greater than 10 degrees in a patient younger than 10 years of age, is greater than 20 degrees in a patient 10 years of age or older, has atypical features or is associated with back pain or neurological abnormalities.

Keywords: Back pain in scoliosis; Idiopathic scoliosis; Nonidiopathic scoliosis; Scoliosis screening.

Figures

Figure 1

Photograph of a patient with idiopathic scoliosis upright (A) and forward bending test (B). Note the rotational asymmetry of the back

Figure 2

Congenital scoliosis – computed tomography depicting a hemivertebrae

Figure 3

Spinal curvature without rotation – other diagnoses apart from idiopathic scoliosis must be considered

Figure 4

A Typical adolescent idiopathic scoliosis requiring correction and fusion; B Fused spine with hook and screw construct