Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis: Pediatrics In Review, August 2006

Case 1
A 14 year old girl presents with spine asymmetry and back pain. She has no neurological  symptoms like changes in bowel or urinary continence and no changes in strength or numbness or tingling.

1. How is scoliosis defined?
2. How is scoliosis assessed on physical exam and what is the best position for the patient to be in during the assessment?
3. What are the three different types of scoliosis and when do they manifest?
4. What is the best initial test to identify scoliosis and what is the Cobb angle? What is important in the neurological exam to perform?
5. How often should screening be performed in the pediatricians office? Is school screening beneficial?
6. What are the indications for a referral to an orthopedist?
7. If the patient had neurological abnormalities or signs of an underlying signal cord problem what imaging should yo as get?
8. What abnormalities would you see in the history physical or imaging that would prompt orthopedics referral
9. What are the treatments available for this patient? In what patient groups has bracing been shown to be less beneficial?
10. In which type of patients is idiopathic adolescent scoliosis more common in? Is there a genetic component?

Case 2
A patient is seen by you who is a young 18 month old whose mother is concerned she is seeing spinal and rib asymmetry in her daughter
1. What would you want to do in terms of imaging in addition to xray if the patient had a significant concerning sacral dimple on exam? What could be the underlying etiology if this was a case?
2. If no underlying etiology is found what kind of scoliosis is this? What are available treatment options?
3. In general What type of scoliosis can cause pulmonary dysfunction?
4. On xray of this patient the Cobb angle is more than 20 degrees. As the general pediatrician what is the next step?