Scoliosis

1. What are the subtypes of idiopathic scoliosis and which are associated with progression?
2. What are the subtypes of congenital scoliosis?
*3. What are the subtypes of curvature?
4. What diagnostic studies are used to assess scoliosis?
5. When is bracing used for scoliosis?
6. When is surgery considered for scoliosis?

Answers:
1. Infantile (<3yrs), often associated with congenital defects. Juvenile is 4-10 yrs, with high risk of progression. Adolescent is most common (10yrs+) and has high risk of prgression.
2. Open is caused by myelomeningocele. Closed is associated with neuro deficits and vertebral deficits.
3. Right thoracic: most common, apex at T7 or T8, double major curve (right thoracic with left lumbar), lumbar, thoracolumbar (may have rib/flank distortion), left thoracic (rare).
4. X-rays are used to establish diagnosis and progression. Rotation can be graded from 0-4 based on the amount of pedicle visible on PA view. Cobb angle measures curve: angle formed by perpendicular line from endplate of most tilted prox and distal vertebrae.
5. Bracing is used with an angle of 20-40 degrees. Less than 20 degrees can be observed. Brace must be worn 23 hours a day until spinal growth is completed; wean when X-ray shows maturity and stable curve. Use a Milwaukee brace for high thoracic curves (apex at T8). If apex below T8, can used low profile TLSO.
6. Surgery for curves with fast progression, >40 degrees in skeletally immature, >50 degrees in skeletally mature, >35 in neuromusc disease, progressive loss of pulmonary function.