Scoliosis

Scoliosis is defined as an abnormal lateral curvature of the spine. It is quite common in young individuals and is often idiopathic and asymptomatic. In some cases, however, it is the result of underlying structural or neurological abnormalities. 

By definition, a scoliosis is any lateral spinal curvature with a Cobb angle greater than 10o, although minor curvatures often require no treatment1.

In most instances, a scoliosis is obvious if severe. On examination, Adam's forward bend test (clinical test for assessing scoliosis) may be positive where a rib hump forms on the side of the convexity.

The majority (80%) of scolioses have not apparent underlying cause and are termed idiopathic 1. Scoliosis can also be broadly divided into being postural or structural.

Postural

Postural scoliosis corrects with lateral flexion towards the convexity of the scoliosis, and is not associated with segmentation abnormalities, or rotational deformity or vertebral body wedging.

Structural

Structural scolioses are the result of a wide variety:

Assessment and monitoring of scolioses is primarily achieved with long-spine plain films in the AP and lateral projections. CT and MRI have roles to play in assessing for underlying abnormalities as well as, in certain situations, preoperative planning. 

Plain radiograph

Examination of spinal films should be systematic, and the following features should be assessed and commented upon 1

  • presence of structural osseous abnormalities
  • major and minor curves
  • apex
  • end vertebrae
  • neutral vertebrae
  • stable vertebra
  • sagittal and coronal balance
Major and minor curves

The major curve is that the curve which is most pronounced and usually develops first 1. The major curve will usually have the structural abnormality if such an abnormality is present. 

Minor curves are compensatory curves, the result of trying to maintain balance in spite of the major curve. They are less pronounced and develop later than the major curve 1

Structural osseous abnormalities

The presence of vertebral body wedging, segmentation abnormalities (such as hemivertebrae), spina bifida or destructive lesions should be sought. 

Apex

The apex is the vertebral body or disc space which demonstrates the greatest rotation and/or furthest deviation from the expected centre of the vertebral column 1

End vertebrae

The end vertebrae are present on either side of the apex and are the vertebrae which are most tilted towards each other 1,4. They form the basis of the Cobb angle

Neutral vertebrae

Neutral vertebrae are present on either side of the apex and are the vertebrae which demonstrate no rotation. In some cases, they will be the same as the end vertebrae although usually, they will be few segments more distal to the apex. They are never closer to the apex than the end vertebrae 1

Stable vertebra

The stable vertebra is the first vertebra below the lowest curve which is roughly bisected by the central sacral vertical line (CSVL)

Sagittal and coronal balance

Sagittal balance and coronal balance refer to the overall alignment of the C7 vertebra with respect the S1 vertebra. They require standing full spine films for assessment. 

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Article Information

rID: 2029
Section: Gamuts
Tag: spine
Synonyms or Alternate Spellings:
  • Spinal scoliosis

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Cases and Figures

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    Scoliosis. Image ...
    Figure 1
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    Case 1: with fused vertebra
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    Case 2: with hemivertebra
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    Case 3: idiopathic scoliosis
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    Case 4: hemivertebrae - congenital scoliosis
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    Osteoblastoma
    Case 5: from osteoblastoma
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    Levoscoliosis wit...
    Case 6: with a syrinx due to a Chiari I
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    SMA : age 12 yrs
    Case 7: with spinal muscular atrophy (SMA) type II
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    Case 8: dorsal spine
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    Case 9: with acute angle
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