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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 64

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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 64. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Spinal Deformities and Malformations Section 623 23 Idiopathic Scoliosis Mathias Haefeli Kan Min Core Messages Idiopathic scoliosis is the most common structural spinal deformity in children and adolescents and affects about 2-3 of the adolescent population An asymmetrical vertebral growth of the anterior column with tethering of the posterior structures may be the cause of the deformity but the exact underlying etiology is unknown Scoliosis is defined as a lateral curvature of the spine of at least 10 with vertebral rotation The most common adolescent idiopathic scoliosis is a thoracic curve to the right side Idiopathic scoliosis is usually accidentally detected as a trunk asymmetry and a rib hump Initial assessment of scoliosis patients includes a physical examination including a thorough neurological examination and anteroposterior lateral radiographs of the whole spine Neurological abnormalities should prompt further investigations MRI neurophysiology Risk factors for curve progression are young age pre-menarchal and large curve size at first presentation During growth curves up to 25 usually do not require specific therapy except observation. Curves between 25 and 40 are usually treated with bracing whereas larger curves often are addressed surgically When not treated surgically thoracic curves between 50 and 70 are most likely to progress in adult life Long-term health related quality of life is comparable with non-affected controls but restrictive pulmonary disease may become a serious health problem in thoracic curves larger than 70 The goal of surgery is to prevent curve progression and correct the spinal deformity Surgery usually consists of curve correction and spinal fusion When spinal instrumentation and fusion is indicated surgical procedures which spare motion segments are favorable The lower lumbar motion segments should be left unfused if possible The reconstruction or preservation of spinal balance is more important than the extent of the curve .