Adolescent idiopathic scoliosis
Summary
定义
病史和体格检查
关键诊断因素
- age >10 years
- signs of the adolescent growth spurt
- 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
其他诊断因素
- shoulder asymmetry
- waist-line asymmetry
- thoracic wall or breast asymmetry
- normal gag reflex
- truncal decompensation
危险因素
- positive family history
- peak adolescent growth spurt
诊断性检查
首要检查
- clinical exam
需考虑的检查
- standing posteroanterior 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
治疗流程
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°
撰稿人
作者
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
利益声明
SLW has received royalties from Wolters Kluwer for text book editing. SLW serves as a member of board of trustees for orthopedic research and education foundation; and he is an author of several references cited in this topic.
鸣谢
Dr Stuart L. Weinstein would like to thank Dr Joshua M. Eisenberg and Dr Ryan M. Ilgenfritz, previous contributors to this topic.
利益声明
JME and RMI declared that they had no competing interests.
同行评议者
Soroush Baghdadi, MD
Fellow
Northwestern University
Evanston, IL
利益声明
SB declares that he has no competing interests.
John Francis Sarwark, MD
Attending Physician
Northwestern University
Evanston, IL
利益声明
JFS declares that he has no competing interests.
John M. (Jack) Flynn, MD
Associate Chief of Orthopaedic Surgery
The Children's Hospital of Philadelphia
Philadelphia, PA
利益声明
JMF declares that he has no competing interests.
Amer Samdani, MD
Director
Pediatric Spine Surgery
Shriners Hospitals for Children
Philadelphia, PA
利益声明
AS is a paid consultant for Synthes Spine, Depuy Spine, and SpineVision.
Andre Tomasino, MD
Neurosurgeon
Department of Neurosurgery
Hospital Munich-Bogenhausen
Munich
Germany
利益声明
AT declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for adolescent idiopathic scoliosis: US Preventive Services Task Force recommendation statement. JAMA. 2018 Jan 9;319(2):165-72.全文 摘要
Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3.全文 摘要
British Scoliosis Society. Standards of care for bracing in adolescent idiopathic scoliosis. Jul 2022 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Congenital scoliosis
- Neuromuscular scoliosis
- Syringomyelia
更多 鉴别诊断指南
- Standards of care for bracing in adolescent idiopathic scoliosis
- Screening for adolescent idiopathic scoliosis: a systematic evidence review for the U.S. Preventive Services Task Force
更多 指南
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