Scoliosis - Scoliosis Andrea Chymiy Swedish Family Medicine...

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Scoliosis Andrea Chymiy Swedish Family Medicine September 24, 2002
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Scoliosis What is it? How do we screen for it? When to refer? How is it treated?
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What is scoliosis? Lateral curvature of the spine >10º accompanied  by vertebral rotation Idiopathic scoliosis - Multigene dominant  no clear cause Multiple causes exist for secondary scoliosis
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Secondary causes for scoliosis: Inherited connective tissue disorders  - Ehler’s Danlos syndrome - Marfan syndrome - Homocystinuria
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Secondary causes for scoliosis: Neurologic disorders Tethered cord  syndrome Syringomyelia Spinal tumor Neurofibromatosis Muscular dystrophy Cerebral palsy Polio Friedeich’s ataxia Familial  dysautonomia Werdnig-Hoffman  disease
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Secondary causes for scoliosis: Musculoskeletal disorders Leg length discrepancy Developmental hip dysplasia Osteogenesis imperfecta Klippel-Feil syndrome
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Characteristics of idiopathic scoliosis: Present in 2 - 4% of kids aged 10 – 16 years Ratio of girls to boys with  small  curves (< 10º) is  equal, but for curves >30º the ratio is 10:1 Scoliosis tends to progress more often in girls  (so girls with scoliosis are more likely to require  treatment)
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Natural history of scoliosis Of adolescents diagnosed with scoliosis, only  10% have curve progression requiring medical  intervention Three main determinants of curve progression  are: (1) Patient gender (2) Future growth potential (3) Curve magnitude at time of diagnosis
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Natural history of scoliosis Assessing future  growth potential using  Tanner staging: Tanner stages 2-3 (just      after onset of pubertal  growth) are the stages of  maximal scoliosis  progression
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Natural history of scoliosis Assessing growth potential using Risser  grading: - Measures progress of bony fusion of iliac   apophysis - Ranges from zero (no ossification) to 5  (complete      bony fusion of the apophysis) - The lower the grade, the higher the potential for    progression
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Risk of Curve Progression Curve (degree) Growth potential ( Risser grade ) Risk 10 to 19 Limited (2 to 4) Low 10 to 19 High (0 to 1) Moderate 20 to 29 Limited (2 to 4) Low/mod 20 to 29 High (0 to 1) High >29 Limited (2 to 4) High >29 High (0 to 1) Very high . *— Low risk = 5 to 15 percent; moderate risk = 15 to 40 percent; high risk = 40 to 70 percent; very high risk = 70 to 90 percent.
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Natural history of scoliosis Back pain not significantly higher in pts with  scoliosis Curves in untreated adolescents with curves <  30 º at time of bony maturity are unlikely to  progress Curves >50 º at maturity progress 1º per year
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Scoliosis - Scoliosis Andrea Chymiy Swedish Family Medicine...

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