Scoliosis

Scoliometer – have patient bend over and place on patient’s back to measure angle of incline. There are also scoliometer apps you can download on your smart phone. 

Background

• Definition: >10° lateral curve to spine with vertebral rotation
• Types: classified as congenital, neuromuscular, or idiopathic. Idiopathic scoliosis is further classified by age: Infantile (0-2 yo), Juvenile (3-9 yo), Adolescent (>10 yo).  Adolescent Idiopathic Scoliosis is the most common form.
• Etiology unknown. Likely polygenic.
• Risk factors for disease progression – initial Cobb angle (angle of curvature of spine) most important factor; Risser grade (more growth potential = more risk of scoliosis progression); sex (male and female have equal incidence, but female more likely to progress)

Screening

• Screening is controversial!
• USPSTF and AAFP do not recommend screening in asymptomatic adolescents. It causes low-risk adolescents to undergo expensive and unnecessary testing and treatments.  Those who actually need treatment will be detected without screening.
• AAP and AAOS both recommend screening.

Cobb Angle

Physical Exam

• Adam’s Forward Bend Test – have patient bend forward at the waist. Stand behind patient and look for rib hump. Use a scoliometer (aka inclinometer) to measure the inclination angle. <5° is insignificant. 5-9° check again in 6 months. >10° is definition of scoliosis and requires XR evaluation to measure Cobb Angle and Risser Grade
• Cobb angle – angle of deviation of the spine
• Risser Grade – amount of ossification of the iliac apophysis, which reflects how much more growth potential a person has. Grade 1 = 25% ossification (lots more growth potential); Grade 2 = 50% ossification; Grade 3 = 75% ossification; Grade 4 = 100% ossification and no more growth potential.

Treatment

• Cobb Angle 10-19; Risser Grade 0-4 – XR q6mo, observe
• Cobb Angle 20-29; Risser Grade 0-1 – XR q6mo, refer, brace after 25° (threshold for long-term curve progression)
• Cobb Angle 20-29; Risser Grade 2-3 – XR q6mo, refer, brace
• Cobb Angle 20-29; Risser Grade 4 – XR q6mo, refer, observe (because no more growth potential, brace won’t help)
• Cobb Angle 30-40; Risser Grade 0-4 – Refer, brace
• Cobb Angle >40; Risser Grade 0-4 – Refer, surgery
• Evidence for brace and surgery are limited. PT, chiropractor, electrical stimulation all have questionable benefits.

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A Quick Guide to Prevention Screening