Consultation with the Specialist: Adolescent Idiopathic Scoliosis

David G. Stewart; David L. Skaggs

doi:10.1542/pir.27-8-299

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David G. Stewart Jr, MD*
David L. Skaggs, MD†

^*Childrens Bone and Spine Surgery, Henderson, Nev
^†Editorial Board

Objectives

After completing this article, readers should be able to:

Discuss the causes and natural history of adolescent idiopathic scoliosis.
List the indications for magnetic resonance imaging in scoliosis patients.
Describe how and when to examine for scoliosis.
Know how to determine the magnitude and pattern of a curve based on standing spine radiographs.
Recognize indications for referral to a specialist.

Case Presentation

A 16-year-old girl presents with a complaint of spine asymmetry and a history of occasional back pain under her right scapula. She denies bowel or bladder problems and has no neurologic complaints. A right rib hump is apparent on the Adams forward bending test, and she has anterior prominence in the left lower rib cage. No neurologic deficit is noted on examination. Her radiographs demonstrate a 55-degree right thoracic scoliosis from approximately T6 to T12 (Fig. 1). On bending films, the curve bends out to 27 degrees. The patient subsequently undergoes posterior spine fusion from T4 to L1 and has an uneventful postoperative course (Fig. 2). She requires no more pain medicine and returns to school within 3 weeks of the surgery. Six months after the surgery, the patient resumes playing soccer.

Figure 1.

A. Preoperative posterior-anterior radiograph. B. Note the thoracic hypokyphosis on the lateral radiograph.

Figure 2.

A. Postoperative posterior-anterior radiograph. B. Postoperative lateral radiograph.

Definitions

Scoliosis is defined as curvature of the spine greater than 10 degrees observed on a standing posterior-anterior (PA) spine radiograph with associated vertebral rotation. The Cobb angle is the angle on the PA view between the superior endplate of the most tilted upper vertebrae and the inferior endplate of the most tilted lower vertebrae.

Scoliosis may occur in association with various conditions. Congenital scoliosis implies failure of segmentation or formation of some vertebral elements and may be associated with fused ribs and spinal cord anomalies. Congenital …