Adolescent Scoliosis

Adolescent Idiopathic Scoliosis

• Adolescent Idiopathic Scoliosis, or AIS, is the most common form of scoliosis and occurs after the age of 10. This is when the spine will curve sideways and twist at the same time. The etiology of AIS is unknown however there is a genetic link. Those with a familiar history of scoliosis are at a higher risk of having scoliosis.
• This type of scoliosis is more common in girls and can increase during rapid times of growth. Girls tend to grow significantly around the time of their menstrual cycle therefore close monitoring of scoliosis is very important. The typical curve pattern in AIS in left lumbar and right thoracic scoliosis however many different patters can occur.

Congenital Scoliosis

• Sometimes scoliosis can be congenital, meaning from birth. Congenital scoliosis often results from an asymmetry in the how the vertebral body was formed that leads to the curvature. Examples of this can be a hemivertebrae where the vertebral body did not completely form in the womb or from a congenital fusion. This type of scoliosis is often seen on radiograph, differentiating itself from adolescent idiopathic scoliosis, and typically manifests before the age of 10.

Neuromuscular Scoliosis

• Neuromuscular scoliosis often occurs as a curvature in patients with an underlying neurologic or musculoskeletal disorder. Common syndromes associated with neuromuscular scoliosis include cerebral palsy, muscular dystrophy, or spina bifida.

Syndromatic Scoliosis

• A syndrome is a condition where multiple symptoms or signs appear together. Scoliosis can often be one of the symptoms associated with an underlying syndrome and may sometimes be the initial presentation. Syndromatic scoliosis can occur with generalized tissue disorders or connective tissue disorders. Some examples include Marfans syndrome or neurofibromatosis.

Especially with the adolescent population, the patient may not be the first to notice a potential scoliosis. Often someone close to the patient such as a parent, pediatrician or coach may be the first to suspect a curvature. Scoliosis often progresses during periods of rapid growth so it is important to evaluate skeletally immature patients for scoliosis. A common diagnostic tool used is the Adams forward bend test. This is when evaluating a patient from behind and he or she bends forward at the waist with knees locked and arms relaxed. This test evaluates for a thoracic or lumbar prominence thus demonstrating the rotation aspect of scoliosis. Specialists will often next use a scoliometer which measures the angle of rotation.

To be diagnosed with adolescent scoliosis the patient must be older than 10 years old. We limit unnecessary radiation exposure with our adolescent patients however radiographs are required to confirm a scoliosis diagnosis. We also utilize radiographs to fully visualize the patient’s entire spine to see the full degree measurement of their scoliosis. Scoliosis is confirmed when radiographs show a curvature of 10 degrees or higher, this measurement is called Cobb angle. Patients skeletal maturity is also estimated by x-rays based on their bony growth plates, called Risser Classification. The Risser classification is from “0,” no ossification, to “5” meaning skeletally mature. A lower Risser score signifies great growth remaining and therefore greater risk for curve progression.

Diagnosis is made by a spinal specialist through physical exam and imaging. When seen as a patient at our office we will do a full physical exam evaluating for physical findings including asymmetric skin folds, shoulder or pelvic height asymmetry, and abnormal deep tendon reflexes. Often, especially in adolescence, a full scoliosis evaluation will warrant more advanced imaging to rule out any other underlying congenital issue.