Scoliosis in Pediatric Patients: Comorbid Disorders and Screening

Authors and Disclosures

Michael P Horan, MD, MS
Chief Resident, Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 740 South Limestone, Suite k-408, Lexington, KY 40536-0248, USA. Tel.: +1 859 218 3044, mphora2@email.uky.edu

Todd A Milbrandt, MD, MS^†
Assistant Professor, Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 740 South Limestone, Suite k-408, Lexington, KY 40536-0248, USA and Shriners Hospital for Children, 1900 Richmond Road, Lexington, KY 40502, USA. Tel.: +1 859 266 2101, Fax: +1 859 323 2412, tmilbrandt@shrinenet.org

^†Author for correspondence
Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 740 South Limestone, Suite k-408, Lexington, KY 40536-0248, USA. Tel.: +1 859 266 2101, Fax: +1 859 323 2412, tmilbrandt@shrinenet.org

Sidebar: Executive Summary

Executive Summary

• Scoliosis is one of the most commonly encountered pediatric spinal deformities.

• Knowledge of comorbid disorders associated with scoliosis is required in order to rule out other serious conditions.

• Screening consists of history of physical exam, focusing on the appearance of the trunk and spine, in addition to a thorough neurologic examination.

• In addition to plain radiographs, MRI scans and ultrasound may be required to rule out comorbid disorders, depending on clinical suspicion.

• The value and effectiveness of school screening programs has been under debate for over 20 years.

• Idiopathic scoliosis is not associated with other medical conditions by definition.

• Congenital scoliosis has a strong association with central axis abnormalities, including intraspinal lesions, heart defects and genitourinary anomalies. Additional screening tests are usually required to rule out these comorbidities.

• Neuromuscular scoliosis is associated with intrinsic neuromuscular disease, including cerebral palsy, muscular dystrophy, spina bifida, poliomyelitis, Friedreich's ataxia, familial dysautonomia (Riley-Day syndrome) or Werdnig-Hoffmann disease.

• Syndrome-associated scoliosis is observed in Neurofibromatosis, Marfan's syndrome, and thoracic wall deformities or postcardiac/thoracic wall surgery.