Scoliosis

Learning objectives

Scoliosis refers to lateral curvature of the spine, vertebral body rotation, and angulation of the rib
These are classified as structural or non-structural (e.g. length discrepancy)
Men and women are equally affected with women often requiring more surgical intervention
Congenital scoliosis:
- May present at any age and is a result of either failure of vertebral segmentation (a bar) or failure of formation (a hemivertebra)
- Congenital scoliosis is often part of a generalized condition, such as Goldenhar syndrome or spina bifida
- It may be associated with abnormalities in renal, cardiac, respiratory, or neurological systems
Acquired scoliosis:
- Mainly idiopathic
- Infantile onset idiopathic scoliosis (scoliosis before the age of 8 years) carries the most serious prognosis and if left unchecked is likely to result in cardiopulmonary failure in middle age

Idiopathic scoliosis is the most common with a wide range of causes	Collagen abnormalities, hormones, genetics, and growth abnormalities
Neuromuscular	Neuropathic Upper motor neuron (e.g. cerebral palsy, spinal cord injury) Lower motor neuron (poliomyelitis, myelomeningocele, spinal muscular atrophy) Familial dysautonomia
Myopathic	Muscular dystrophy Myotonic dystrophy
Congenital	Hemivertebrae Congenitally fused ribs
Neurofibromatosis	Marfan’s syndrome Osteogenesis imperfecta Arthrogryposis
Trauma	Vertebral fracture or surgery Post thoracoplasty Post radiation

Neuromuscular scoliosis has been associated with increased intraoperative blood loss compared with idiopathic scoliosis

Cobb Angle:
- Measured from a standing anteroposterior radiograph of the spine
- The surgical treatment is recommended if the cobb angle is greater than 45° – 50°
- Degree of Cobb Angle associated with pulmonary and cardiovascular dysfunction

Decreased overall lung function (restrictive) with significantly reduced vital capacity and respiratory muscle function can be impaired as well
An increased pulmonary vascular resistance and pulmonary hypertension, possibly leading to right ventricle hypertrophy and failure
Increased risk of mitral valve prolapse
Increased risk for malignant hyperthermia if scoliosis results from muscular dystrophies
Potential difficult airway

Rigid bracing (thoracolumbosacral orthosis)
- Indicated for a progressive curve greater than 25°
- Results depend on compliance (social stigma and discomfort)
Serial full-body casting
- Indicated for infantile scoliosis
- General anesthesia is required every 2-3 months