In this lecture, we’re going to review scoliosis in children. So, scoliosis is a condition where the spine
is abnormally curved. There are a few different causes that we can think about. The most common cause
is idiopathic. This is more common in girls than in boys and usually happens around the age of 10 to 14
years of age. It’s during that pubertal growth spurt. It’s less common earlier but can happen
or patients may have a congenital scoliosis. This is from a structural defect in the spine. This is associated
with spinal defects like hemivertebrae or spina bifida or certain syndromes such as VACTERL syndrome
which you’ll learn about in your genetics lectures. Alternatively, this could be related to other disorders
of the muscle and it could be just related to weakness. Examples of that include cerebral palsy
or muscular dystrophy. Whatever the case, scoliosis is generally not a painful condition.
If there's pain, something else might be going on. Also, over time, it may become painful.
So, we'd want to correct it while it’s not in it’s painful stage early in childhood. So, how do we check
for scoliosis? This is an example of an excellent way to examine a child for scoliosis.
We’re going to stand behind the patient and ask them to touch their toes. Then if we wish,
we can use a scoliometer. This is an instrument that can measure the degree of angulation
that is outside of normal. If on your scoliometer, the patient has an angle of more than seven degrees,
that’s an indication to get a spine X-ray. Sometimes it’s beneficial after the child bends over
to ask them to slowly rise. That way, you can assess the curvature all the way along the spine.
So, let us say we go ahead and get an X-ray. Here is an example of an X-ray with a very substantial scoliosis.
What we’ll then do is we’ll draw lines on the X-ray. You want to draw lines above and below
the curvature of the spine. Then you want to assess the angle between those two lines.
That angle is called the Cobb angle. So, you’re going to refer to an orthopedist if the Cobb angle
is more than 20 degrees if they’re prepubertal and if it’s more than 30 degrees in any patient.
The progression of a Cobb angle over time by more than 5 degrees is also a reason to refer
to the orthopedist. So, most forms of scoliosis are treated with bracing. However, in severe cases,
orthopedist will take these children to the OR and they will do a surgical procedure which is fairly invasive.
You can see here what they've done is they've drilled into the bodies of the vertebrae and physically
straightened out that vertebrae with instrumentation. There is a risk for surgery. It includes chronic pain,
immobility, and there’s a risk for infection on the hardware which can be incredibly challenging to treat.
But generally speaking, the vast majority of patients are treated effectively with bracing.
Their Cobb angle will resolve. They can live long and happy, productive lives.
Thanks for your attention.