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Idiopathic Scoliosis

By

Frank Pessler

, MD, PhD, Hannover, Germany

Last full review/revision Oct 2020| Content last modified Oct 2020
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Idiopathic scoliosis is lateral curvature of the spine. Diagnosis is clinical and includes spinal x-rays. Treatment depends on the severity of the curvature.

Idiopathic scoliosis is the most common form of scoliosis and is present in 2 to 4% of children aged 10 to 16 years. Boys and girls are equally affected; however, it is 10 times more likely to progress and require treatment in girls.

Genetic factors contribute about one third of the risk of disease development. Mutations in the CHD7 and MATN1 genes have been implicated in some cases.

Symptoms and Signs of Idiopathic Scoliosis

Scoliosis may first be suspected when one shoulder seems higher than the other or when clothes do not hang straight, but it is often detected during routine physical examination. Other findings include apparent leg-length discrepancy and asymmetry of the chest wall. Patients may initially report fatigue in the lumbar region after prolonged sitting or standing. Muscular backaches in areas of strain (eg, in the lumbosacral angle) may follow.

Diagnosis of Idiopathic Scoliosis

  • X-ray of the spine

The curve is most pronounced when patients bend forward. Most curves are convex to the right in the thoracic area and to the left in the lumbar area, so that the right shoulder is higher than the left. X-ray examination should include standing anteroposterior and lateral views of the spine.

Cobb angle

In the Cobb method, two lines are drawn on a posterior-anterior x-ray of the spine, one extending from the top of the most tilted upper vertebra and the other from the bottom of the most tilted lower vertebra. The angle formed by these lines is the Cobb angle.

Cobb angle

The amount of curvature is quantified in degrees based on x-ray findings (the Cobb method). In this method, two lines are drawn on a posterior-anterior x-ray of the spine, one extending from the top of the most tilted upper vertebra and the other from the bottom of the most tilted lower vertebra. The angle formed by these lines is the Cobb angle.

Prognosis for Idiopathic Scoliosis

The greater the curve, the greater the likelihood that it will progress after the skeleton matures. Curves > 10° are considered significant. Prognosis depends on site and severity of the curve and age at symptom onset. Significant intervention is required in < 10% of patients.

Treatment of Idiopathic Scoliosis

  • Physical therapy and bracing

  • Sometimes surgery

Prompt referral to an orthopedist is indicated when progression is of concern or the curve is significant. Likelihood of progression is greatest around puberty. Moderate curves (20 to 40°) are treated conservatively (eg, physical therapy and bracing) to prevent further deformity.

Severe curves (> 40°) may be ameliorated surgically (eg, spinal fusion with rod placement).

Scoliosis and its treatment often interfere with an adolescent’s self-image and self-esteem. Counseling or psychotherapy may be needed.

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