Update on scoliosis in children and adolescents

Key Points

Scoliosis is a relatively common childhood disorder that can affect infants, children, and adolescents. Scoliosis is typically considered a deformity of the spine in the coronal or frontal plane; however, spinal deformities are complex and include deviations not only in the frontal but also in the sagittal and transverse planes.¹ Understanding the unique pathoanatomy of scoliosis has led to the development of innovative techniques and technologies designed to correct or counteract deforming influences on the spine.

Definitions

Scoliosis can be categorized in terms of age of onset and etiology. The most common form of scoliosis is idiopathic scoliosis; as the name implies, its etiology is unknown. Scoliosis that is a manifestation of other diseases such as cerebral palsy or muscular dystrophy is termed neuromuscular scoliosis. Congenital spinal anomalies typically arise in utero and may involve failure of formation (hemivertebra) or failure of segmentation (block vertebra); these anomalies may result in more complex congenital scoliosis or kyphosis. Congenital spinal deformities may present early in the newborn period or sometimes as late as adolescence and may also include chest abnormalities such as fused ribs.

Typically, the term early onset scoliosis is used to describe scoliosis of any etiology that presents before the patient is 5 years of age and late onset scoliosis is used for scoliosis diagnosed when the patient is older than 5 years.

Diagnosis

Scoliosis is diagnosed primarily through a physical examination, typically when the physician views the patient from behind. Asymmetries at the waistline or flank area and shoulder prominence are typical findings in patients with scoliosis. The Adam's forward bend test is the most common means to evaluate scoliosis, with rotation of the trunk the usual finding. Referral to an orthopedist is typically warranted when a patient's trunk rotation or rib prominence on physical exam exceeds 5° by scoliometer measurement. A curve documented by radiograph with a reliably measured scoliosis of 20° in a growing child or adolescent also warrants a referral. In light of the epidemic of obesity among US children and adolescents, special care must be taken in the office to assess the overweight or obese adolescent for scoliosis because physical exam findings may be subtle.

At this time, 33 states provide school screening for scoliosis, the value of which has been questioned by the US Preventive Services Task Force (USPSTF), which recommended against it.⁴ Currently, the American Academy of Pediatrics (AAP), Scoliosis Research Society, and Pediatric Orthopaedic Society of North America all continue to support school screening for scoliosis.⁵ There are still legitimate concerns about over-referral and the costs of the program.^4,5