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Developmental Dislocation of the Hips

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Pertussis Notification

Scoliosis Detection and Management

Scoliotic Deformity. AIS develops about 10 years of age in a previously normal spine. It deforms in the coronal and sagittal planes together with rotation in its long axis. The vertebral body rotates to the convex side and the spinous processes to the concave. The ribs follow the vertebrae rotating backwards and upwards on the convex side and forward to a lesser degree on the concave.

Curve patterns. The right thoracic curve is the most common pattern followed by the left lumbar curve.

Prevalence. 2%-3% for curves 10 degrees or more; 0.1 % for curves >40 degrees.

Sex incidence. The male-female ratio for curves warranting treatment is 1:10.

Diagnosis. This is best made when the trunk is viewed from behind. In a right thoracic curve the right shoulder is elevated and the left arm may appear longer. The right scapula moves upwards and laterally with a prominent medial edge. Because of trunk rotation, the left breast may be more prominent than the right. Flank creases may be asymmetrical in an overweight girl. The gaps between the dependent arms and the trunk are unequal. The left iliac crest (hip) is more prominent than the right. The latter may be the presenting sign in thoracolumbar and lumbar curves. The forward-bend test (FBT). This diagnostic physical sign is based on fixed (structural) vertebral column rotation. The subject bends maximally forward with outstretched arms, palms facing each other, pointed towards the great toes with the feet together. This brings the rib prominence or lumbar muscles into silhouette. A significant curve is likely if the difference between the height of the two sides is > 1 cm. Torso asymmetry. This is the most common reason for a false positive FBT. It is due to asymmetrical growth/development of normal girls. Here, in the FBT, the difference between the height of the two sides is < 1 cm. The other signs of scoliosis are absent. If you are having difficulty deciding whether or not a girl has a curve, then almost certainly she does not. Such asymmetry is of no clinical significance.

Rear view [Macro error: Can't locate an image object named "scolio2a.jpg".] Frontal view

Symptoms. In the early stages, AIS causes no symptoms. A painful scoliosis is an indication for investigation for underlying pathology such as tumour-.   Curve measurement (7he Cobb Angle). This must be done accurately on an erect PA film (diagram). The minimal angle for diagnosis is 10 degrees with vertebral rotation.   Scoliosis of other aetiologies. AIS is a diagnosis by exclusion. A full physical examination is required. Curvature may be associated with neuromuscular disease, connective tissue, disorder and congenital vertebral abnormalities. Specialist referral is recommended for these conditions. A true or apparent limb shortening may produce a lumbar tilt but not a scoliosis. This is because there is no vertebral rotation. A short leg "scoliosis" disappears on sitting and in the FBT.

  Management. This is based on the age at presentation and the degree of curvature. The risk for progression is established (table) and this most likely occurs in the growth spurt (11-13 yrs). Early breast development marks spurt onset.

Minor curves (<20 degrees) are common but only 3 adolescent girls per 1000 have a curve which requires active treatment, either by bracing or surgery.