Scoliosis

Definition

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Epidemiology
Occurs in 2-4% of the population * Females are affected about five times as o f t M
as males Most often diagnosed in childhood or adolescence.
Etiology, pathophysiology, pathogenesis
Scoliosis is defined as an abnormal lateral curvature of the spine.
Classification according to plane of curvature:
- Right or left scoliosis (lateral deviation in the coronal plane).
- Rotoscoliosis (rotation in the axial plane).
- Kyphoscoliosis and lordoscoliosis (kyphotic and lordotic components in the
sagittal plane).
Classification by shape:
- S-shaped scoliosis (double deviation w i t h curve and reverse curve).
- C-shaped scoliosis (single curve w i t h o u t reverse curve).
End vertebrae: The most proximal and distal vertebrae of a curve The vertebra
at which the curve changes direction to become the reverse curve * The vertebra
w i t h the greatest tilt toward the concavity and usually the one least rotated.
Neutral vertebra: The vertebra in a curve which exhibits no rotation (its alignment often matches that of the end vertebra).
Apical vertebra: The vertebra in a curve which is furthest from normal position
and exhibits the greatest rotation.
Structural curve: Remains present in lateral bending views Morphologic vertebral changes are seen (wedge vertebra, rotation).
Nonstructural (functional) curve: Usually only slight, not progressive, and disappears completely w i t h ipsilateral bending.
Primary curve: Largest structural curve.
Secondary curve: Lesser curve.
Compensatory curve: Curve located above or below the main curve.

Imaging Signs
Modality of choice
Conventional radiographs.
CT studies w i t h coronal, sagittal, and possibly three-dimensional reconstructions may prove helpful in preoperative planning.
Supplementary MRI studies may be obtained when bone and spinal cord pathology is suspected (coronal and sagittal Tl-weighted and T2-weighted slices, and
also axial T2-weighted slices at the level of the suspected pathology).
Radiographic findings
A-P view w i t h the patient standing (from occiput to sacrum) to measure the severity of scoliosis Lateral view w i t h the patient standing to evaluate additional
abnormal curves in the sagittal plane (required during initial examination as
well as preoperatively and postoperatively) * Preoperative lateral bending views
differentiate between structural and nonstructural curves * Cobb method of scoliosis measurement. The Cobb angle is determined as follows: Draw a line in the
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live changes (narrowed disk interspaces

subchondral sclerosis, osteophytes) with
right convex scoliosis.

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C o n v e n t j o n a

g i H

w i t n

radi

S-shaped

ograph

obtained with patient standing (overlaid

with grid).

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