Scoliosis

Overview

Definition

Scoliosis is a lateral spinal curvature of the spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy greater than 10 degrees in the coronal Coronal Computed Tomography (CT) plane, usually accompanied by rotation Rotation Motion of an object in which either one or more points on a line are fixed. It is also the motion of a particle about a fixed point. X-rays of variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables amounts.

• Dextroscoliosis: spinal curvature to the right 
• Levoscoliosis: spinal curvature to the left 

Epidemiology

• Incidence Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time. Measures of Disease Frequency: 10 in 200 children by age 10–15 
• Only 1 in 200 patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship become symptomatic.
• 70%–90% of cases are idiopathic Idiopathic Dermatomyositis (unknown cause).
• Girls have an increased likelihood of progression (rapid growth → increased curvature change).
• Most common type is idiopathic Idiopathic Dermatomyositis, followed by congenital Congenital Chorioretinitis.
• Most common type in the pediatric population: adolescent idiopathic Idiopathic Dermatomyositis scoliosis (AIS) 

Classification

• Scoliosis is broadly divided into primary ( idiopathic Idiopathic Dermatomyositis) and secondary to underlying conditions:
  • Type I: primary degenerative (de novo) scoliosis
  • Type II: progressive AIS with secondary degenerative changes Degenerative Changes Spinal Stenosis
  • Type III: scoliosis secondary to another pathologic condition:
    • Marfan syndrome Marfan syndrome Marfan syndrome is a genetic condition with autosomal dominant inheritance. Marfan syndrome affects the elasticity of connective tissues throughout the body, most notably in the cardiovascular, ocular, and musculoskeletal systems. Marfan Syndrome
    • Chiari malformation
    • Syringomyelia Syringomyelia Longitudinal cavities in the spinal cord, most often in the cervical region, which may extend for multiple spinal levels. The cavities are lined by dense, gliogenous tissue and may be associated with spinal cord neoplasms; spinal cord traumatic injuries; and vascular malformations. Syringomyelia is marked clinically by pain and paresthesia, muscular atrophy of the hands, and analgesia with thermoanesthesia of the hands and arms, but with the tactile sense preserved (sensory dissociation). Lower extremity spasticity and incontinence may also develop. Central Cord Syndrome
  • Type IIIA: lumbosacral scoliosis caudal to a previous spinal fusion
  • Type IIIB: scoliosis secondary to metabolic bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types disease (e.g., osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis) combined with asymmetric degenerative disease and/or vertebral fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures
• Scoliosis can also be classified according to reversibility:
  • Structural: Structural curves do not resolve with movement.
  • Functional:
    • Structurally normal spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy
    • Spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy appears curved due to other conditions (e.g., different leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy length, muscle spasms Spasms An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. Ion Channel Myopathy)
    • Curvature can be reduced with side- or forward-bending motions.
  • Change from functional to structural:
    • Progressive soft tissue Soft Tissue Soft Tissue Abscess shortening
    • Body changes
    • Disk degeneration
    • Fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans of ligaments and fascia Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests muscles, nerves, and other organs. Cellulitis
    • Decreased active and passive range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs (ROM)
• Classification according to severity:
  • Mild: 10–15 degrees
  • Moderate: 20–45 degrees
  • Severe: > 50 degrees
• Classification according to cause:
  • Idiopathic Idiopathic Dermatomyositis
  • Congenital Congenital Chorioretinitis
  • Acquired/secondary
  • Neuromuscular

Pathophysiology

Scoliosis can develop de novo or as a continuation of congenital Congenital Chorioretinitis, idiopathic Idiopathic Dermatomyositis, or early-developed scoliosis. The uneven loading of the spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy produces and exacerbates the pathological curvature seen in scoliosis. 

• Congenital Congenital Chorioretinitis scoliosis:
  • Congenital Congenital Chorioretinitis structural defect of the spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy 
  • Failure of vertebrae to form or merge 
  • Hemivertebrae, neural tube Neural tube A tube of ectodermal tissue in an embryo that will give rise to the central nervous system, including the spinal cord and the brain. Lumen within the neural tube is called neural canal which gives rise to the central canal of the spinal cord and the ventricles of the brain. Gastrulation and Neurulation defects (spina bifida)
  • Can be unilateral or bilateral
• Acquired scoliosis:
  • Tissue or mechanical alterations force the vertebral column Vertebral column The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy adapt to a pathological position that produces spinal curving:
    • Osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic bone matrix leading to bone softening, bone pain, and weakness. It is the adult form of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets
    • Sciatica
    • Psoas syndrome
    • Healed leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy or hip fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures
    • Cerebral palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies
  • Asymmetric degeneration of intervertebral disk and facet joints due to osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis
  • Neuromuscular:
    • Leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy length discrepancy Length Discrepancy Blount’s Disease
    • Neurofibromatosis
    • Quadriplegia Quadriplegia Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending corticospinal and corticobulbar tracts. Locked-in Syndrome

Clinical Presentation

History

• Pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways:
  • Sharp and/or burning pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways 
  • Associated with movement
  • Resolves spontaneously
• Patient complaints will vary depending on the age group:
  • Children: juvenile idiopathic Idiopathic Dermatomyositis scoliosis
    • Often asymptomatic
    • More progressive than adolescent idiopathic Idiopathic Dermatomyositis scoliosis (AIS)
    • Check between ages 10 and 15 when rapid bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types growth is occurring: Asymmetry Asymmetry Examination of the Upper Limbs may be noted.
  • Adolescents complain of their clothes not fitting.
  • Adults present with:
    • Symptoms of osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis
    • Back and neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • Headache Headache The symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders. Brain Abscess
    • Some patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship may report chest pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways.
• Important history questions to address:
  • Age of onset
  • Rate of progression
  • Features of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
  • Neuromuscular complaints
  • Dyspnea Dyspnea Dyspnea is the subjective sensation of breathing discomfort. Dyspnea is a normal manifestation of heavy physical or psychological exertion, but also may be caused by underlying conditions (both pulmonary and extrapulmonary). Dyspnea 
  • Family history Family History Adult Health Maintenance of scoliosis
  • Current pubertal stage
  • Onset of menarche Menarche The first menstrual cycle marked by the initiation of menstruation. Menstrual Cycle (girls)
  • History of limb trauma, infection, arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis

Physical examination

• Document the height of the patient.
• Stage of puberty Puberty Puberty is a complex series of physical, psychosocial, and cognitive transitions usually experienced by adolescents (11-19 years of age). Puberty is marked by a growth in stature and the development of secondary sexual characteristics, achievement of fertility, and changes in most body systems. Puberty
• Neurological examination Neurological examination A neurological exam is a systematic assessment of cognitive, sensory, and motor responses to identify pathologies of the nervous system. A neurological exam allows for the localization of neurologic lesions to narrow the differential diagnosis and focus on subsequent laboratory and imaging examinations. The exam should include assessments of the subject’s mental status, speech, cranial nerves, motor system, deep tendon reflexes, sensation, balance, and coordination. Neurological Examination for weakness and gait Gait Manner or style of walking. Neurological Examination
• Skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions: Check for café au lait spots associated with neurofibromatosis.
• Musculoskeletal:
  • Adams forward bend test:
    • Examine the back when the individual is bent forward.
    • Look for back asymmetry Asymmetry Examination of the Upper Limbs (such as a rib hump or lumbar prominence).
    • Typical “double curve” in AIS is right thoracic and left lumbar.
  • Hyperlaxity of joints: possible Ehler-Danlos syndrome 
  • Feet:
    • Flat feet
    • High arches
    • Hammer/claw toes
  • Symmetry:
    • Upper limbs
    • Level of occiput, shoulders, iliac crests, posterior superior iliac spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy, posterior inferior iliac spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy, and greater trochanters
    • Lower limb length
• Scoliometer:
  • Measures the angulation Angulation Buckle or Torus Fracture of the spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy (angle of trunk rotation Rotation Motion of an object in which either one or more points on a line are fixed. It is also the motion of a particle about a fixed point. X-rays) while the individual bends forward:
    • Have a consistent, standardized way to measure every time.
    • Always use the same type of instrument on follow-up exams.
  • Deviation of the ball (in the meter) from the center is noted in scoliosis.

Diagnosis

Diagnosis is initially made clinically and later confirmed by X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests, which will show the presence of spinal curvature. Idiopathic Idiopathic Dermatomyositis scoliosis is a diagnosis of exclusion.

• Screening Screening Preoperative Care programs in schools 
• Spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests: if screening Screening Preoperative Care is abnormal
  • Standing posteroanterior (PA) view and measuring the Cobb angle:
    • Draw a line at the superior border of the highest vertebra inclined toward the concavity and then draw a line perpendicular to this.
    • Draw a line at the inferior border of the lowest vertebra inclined toward the concavity and then draw a line perpendicular to this.
    • The Cobb angle is the degrees measured at the intersection of the 2 perpendicular lines.
    • The Cobb angle will be greater than the angle of trunk rotation Rotation Motion of an object in which either one or more points on a line are fixed. It is also the motion of a particle about a fixed point. X-rays. An angle of truck rotation Rotation Motion of an object in which either one or more points on a line are fixed. It is also the motion of a particle about a fixed point. X-rays of 7° correlates to a Cobb angle of 20°.
  • Lateral-bending X-rays X-rays X-rays are high-energy particles of electromagnetic radiation used in the medical field for the generation of anatomical images. X-rays are projected through the body of a patient and onto a film, and this technique is called conventional or projectional radiography. X-rays
  • Note the details for future comparison:
    • Direction of curvature (dextro or levo)
    • Location: level of cervical, thoracic, or lumbar spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy
    • Other radiologic findings such as masses, congenital Congenital Chorioretinitis vertebral lesions, or vertebral body Vertebral body Main portion of the vertebra which bears majority of the weight. Vertebral Column: Anatomy lucencies
• MRI spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy indications:
  • Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship under age 10 (to check for possible spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy abnormalities)
  • Rapid progression (Cobb angle ≥ 10° per year)
  • In patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with:
    • Increased pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • Associated neurologic symptoms
    • Abnormal findings on the plain radiographs
• Labs: requested according to clinical suspicion of underlying etiologies, according to the age group

Management

Management ranges from conservative to surgical depending on the degree of scoliosis.

Treatment

• Conservative therapy:
  • Goal is to optimize the patient’s function.
  • Observation with exam and X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests (PA view) every 4–6 months
  • Bracing to slow progression
  • Osteopathic manipulative therapy
  • Home exercise program
  • Physical therapy Physical Therapy Becker Muscular Dystrophy and chiropractic are ineffective.
• Orthopedic referral:
  • If unable to measure the Cobb angle 
  • For a Cobb angle 20–29 degrees in a premenarchal girl or boy aged 12–14 (skeletal growth remaining)
  • For a Cobb angle > 30 degrees in any patient
  • Rapid progression of Cobb angle more than 5 degrees
• Goals of surgery:
  • Primary: utilizing spinal fusion for prevention of curve progression
  • Secondary: Partial curve correction is frequently achieved.
• Surgical indications:
  • At diagnosis, the patient has a Cobb angle of ≥ 50 degrees
  • Sometimes, skeletally immature patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with Cobb angle between 40 and 50 degrees may need surgery.
• Surgical procedures: bone grafting Bone Grafting Benign Bone Tumors, spinal fusion (anterior or posterior) and instrumentation
  • Has evolved from the Harrington rods (cephalad and caudad spinal connections with hooks) to modern segmental instrumentation (hooks, screws, wires, rods)
  • Most important part of the surgery is obtaining bony fusion: autograft Autograft Transplant comprised of an individual’s own tissue, transferred from one part of the body to another. Organ Transplantation or allograft
  • Postoperative period Postoperative period The period following a surgical operation. Postoperative Care:
    • No sports for 9–12 months until the spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy has fused
    • No collision sports after spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy has fused
    • Potential complications of surgery: chronic pain Chronic pain Aching sensation that persists for more than a few months. It may or may not be associated with trauma or disease, and may persist after the initial injury has healed. Its localization, character, and timing are more vague than with acute pain. Pain Management, infection of the hardware

Complications

• Progression of the deformity Deformity Examination of the Upper Limbs if untreated.
• Sacral base unleveling
• Cardiac and pulmonary restriction
• Chronic back pain Chronic Back Pain Back Pain
• Cosmetic issues
• Nerve injury Nerve Injury Surgical Complications
• Spinal disk herniation Herniation Omphalocele and lumbar radiculopathy Lumbar Radiculopathy Spinal Disk Herniation
• Ankylosing spondylitis Ankylosing spondylitis Ankylosing spondylitis (also known as Bechterew’s disease or Marie-Strümpell disease) is a seronegative spondyloarthropathy characterized by chronic and indolent inflammation of the axial skeleton. Severe disease can lead to fusion and rigidity of the spine. Ankylosing Spondylitis

Prognosis Prognosis A prediction of the probable outcome of a disease based on a individual’s condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas

The prognosis Prognosis A prediction of the probable outcome of a disease based on a individual’s condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas of scoliosis is dependent on the underlying cause, comorbidities Comorbidities The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. St. Louis Encephalitis Virus, and deformity Deformity Examination of the Upper Limbs at the time of presentation. 

• Progression:
  • Seen in up to 70% of adult scoliosis patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship 
  • Untreated scoliosis: 0.5 to 1 degree/year
  • Progression is not affected by pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care.
  • Pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care is not affected by scoliosis.
• Back pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways:
  • Slightly increased occurrence of back pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways in adults with AIS, whether treated or untreated
  • Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with AIS treated with bracing or surgery may also have an increased incidence Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time. Measures of Disease Frequency of degenerative disk changes.

Clinical Relevance

The following conditions are associated with scoliosis:

• Marfan syndrome Marfan syndrome Marfan syndrome is a genetic condition with autosomal dominant inheritance. Marfan syndrome affects the elasticity of connective tissues throughout the body, most notably in the cardiovascular, ocular, and musculoskeletal systems. Marfan Syndrome: a genetic condition with autosomal dominant inheritance Autosomal dominant inheritance Autosomal Recessive and Autosomal Dominant Inheritance. Marfan syndrome Marfan syndrome Marfan syndrome is a genetic condition with autosomal dominant inheritance. Marfan syndrome affects the elasticity of connective tissues throughout the body, most notably in the cardiovascular, ocular, and musculoskeletal systems. Marfan Syndrome affects the elasticity Elasticity Resistance and recovery from distortion of shape. Skeletal Muscle Contraction of connective tissues throughout the body, most notably in the cardiovascular, ocular, and musculoskeletal systems. The skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions, lungs Lungs Lungs are the main organs of the respiratory system. Lungs are paired viscera located in the thoracic cavity and are composed of spongy tissue. The primary function of the lungs is to oxygenate blood and eliminate CO2. Lungs: Anatomy, and CNS are also affected.
• Chiari malformation: a group of CNS conditions characterized by the underdevelopment of the posterior cranial fossa Underdevelopment of The Posterior Cranial Fossa Chiari Malformations, with subsequent protrusion of neural structures through the foramen magnum. 
• Cerebral palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies (CP): a syndrome of motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology impairment caused by a non-progressive CNS injury. Cerebral palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies is classified according to muscle tone Muscle tone The state of activity or tension of a muscle beyond that related to its physical properties, that is, its active resistance to stretch. In skeletal muscle, tonus is dependent upon efferent innervation. Skeletal Muscle Contraction, its distribution, and the presumed time of injury (spastic diplegia is the most common), and is present in about 3 of 1,000 live births. 
• Spinal disk herniation Herniation Omphalocele: a condition characterized by the degeneration of the annulus fibrosus Annulus Fibrosus Spinal Disk Herniation and the herniation Herniation Omphalocele of the nucleus pulposus Nucleus Pulposus Fibrocartilage inner core of the intervertebral disc. Prolapsed or bulged nucleus pulposus leads to intervertebral disc displacement while proliferation of cells in the nucleus pulposus is associated with intervertebral disc degeneration. Spinal Disk Herniation of the intervertebral discs. Spinal disk herniation Herniation Omphalocele usually presents as radiculopathy Radiculopathy Disease involving a spinal nerve root which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. Rheumatoid Arthritis (most commonly lumbar) due to the pressure exerted by the herniated nucleus pulposus Nucleus Pulposus Fibrocartilage inner core of the intervertebral disc. Prolapsed or bulged nucleus pulposus leads to intervertebral disc displacement while proliferation of cells in the nucleus pulposus is associated with intervertebral disc degeneration. Spinal Disk Herniation. 
• Ankylosing spondylitis Ankylosing spondylitis Ankylosing spondylitis (also known as Bechterew’s disease or Marie-Strümpell disease) is a seronegative spondyloarthropathy characterized by chronic and indolent inflammation of the axial skeleton. Severe disease can lead to fusion and rigidity of the spine. Ankylosing Spondylitis: a spondyloarthropathy Spondyloarthropathy Ankylosing Spondylitis characterized by chronic and indolent inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of the axial Axial Computed Tomography (CT) skeleton. The condition is most often seen in young men and is strongly associated with HLA-B27. Severe disease can lead to fusion and rigidity Rigidity Continuous involuntary sustained muscle contraction which is often a manifestation of basal ganglia diseases. When an affected muscle is passively stretched, the degree of resistance remains constant regardless of the rate at which the muscle is stretched. This feature helps to distinguish rigidity from muscle spasticity. Megacolon of the spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy. 
• Juvenile idiopathic Idiopathic Dermatomyositis arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis: formerly known as juvenile rheumatoid arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis, a heterogeneous group of inflammatory diseases characterized by arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis and the most common pediatric rheumatic disease.
• Osteoblastoma Osteoblastoma A benign, painful, tumor of bone characterized by the formation of osteoid tissue, primitive bone and calcified tissue. It occurs frequently in the spine of young persons. Benign Bone Tumors: a benign Benign Fibroadenoma, bone-forming tumor Tumor Inflammation most commonly located at the posterior elements of the spine Spine The human spine, or vertebral column, is the most important anatomical and functional axis of the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and is limited cranially by the skull and caudally by the sacrum. Vertebral Column: Anatomy causing symptoms of nerve root compression Compression Blunt Chest Trauma.
• Neurofibromatosis type 1 Type 1 Spinal Muscular Atrophy: a neurocutaneous disorder that causes the growth of tumors in the nervous system Nervous system The nervous system is a small and complex system that consists of an intricate network of neural cells (or neurons) and even more glial cells (for support and insulation). It is divided according to its anatomical components as well as its functional characteristics. The brain and spinal cord are referred to as the central nervous system, and the branches of nerves from these structures are referred to as the peripheral nervous system. Nervous System: Anatomy, Structure, and Classification and skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions and is characterized clinically by café au lait spots on the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions.