Summary
Definition
History and exam
Key diagnostic factors
- age >10 years
- 6 to 12 months post puberty
- postural asymmetry
- absent or minimal pain
- absence of neurologic symptoms with normal neurologic exam
- paraspinal prominences on forward bending
- scoliometer measurement of >5° at paraspinal prominence
- symmetric abdominal reflexes
Other diagnostic factors
- shoulder asymmetry
- waist-line asymmetry
- thoracic wall or breast asymmetry
- normal gag reflex
- truncal decompensation
Risk factors
- positive family history
- peak adolescent growth spurt
Diagnostic tests
1st tests to order
- clinical exam
Tests to consider
- standing PA x-rays of cervical, thoracic, and lumbar spine, and pelvis
- standing lateral x-rays of cervical, thoracic, and lumbar spine, and pelvis
- MRI of cervical, thoracic, lumbar, and sacral spine, and brainstem
Treatment algorithm
screening scoliometer measurement <5° or coronal Cobb angle measurement of ≤10°
standing coronal Cobb angle measurement of 11° to 20°
standing coronal Cobb angle measurement of 21° to 45°
standing coronal Cobb angle measurement of >45°
Contributors
Authors
Joshua M. Eisenberg, MD
Clinical Research Fellow
Department of Orthopaedics and Rehabilitation
University of Iowa Hospitals and Clinics
Iowa City
IA
Disclosures
JME declares that he has no competing interests.
Stuart L. Weinstein, MD
Ignacio V. Ponseti Chair and Professor of Orthopaedics
Department of Orthopaedics and Rehabilitation
University of Iowa Hospitals and Clinics
Iowa City
IA
Disclosures
SLW has received royalties from Wolters Kluwer for text book editing. SLW is a former board member of the Journal of Bone and Joint Surgery (ended in 2013); he was involved in a NIH RO1 research grant programme until 2015; and he is an author of several references cited in this topic.
Acknowledgements
Dr Stuart L. Weinstein and Dr Joshua M. Eisenberg would like to thank Dr Ryan M. Ilgenfritz, a previous contributor to this topic.
Disclosures
RMI declared that he had no competing interests.
Peer reviewers
John M. (Jack) Flynn, MD
Associate Chief of Orthopaedic Surgery
The Children's Hospital of Philadelphia
Philadelphia
PA
Disclosures
JMF declares that he has no competing interests.
Amer Samdani, MD
Director
Pediatric Spine Surgery
Shriners Hospitals for Children
Philadelphia
PA
Disclosures
AS is a paid consultant for Synthes Spine, Depuy Spine, and SpineVision.
Andre Tomasino, MD
Neurosurgeon
Department of Neurosurgery
Hospital Munich-Bogenhausen
Munich
Germany
Disclosures
AT declares that he has no competing interests.
Differentials
- Congenital scoliosis
- Neuromuscular scoliosis
- Syringomyelia
More DifferentialsGuidelines
- Adolescent idiopathic scoliosis
- Screening for adolescent idiopathic scoliosis: a systematic evidence review for the U.S. Preventive Services Task Force
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