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Idiopathic Scoliosis Workup

  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Jeffrey A Goldstein, MD  more...
 
Updated: Jan 29, 2016
 

Laboratory Studies

Laboratory workup for patients with scoliosis consists primarily of preoperative testing. Most, if not all, patients undergo preoperative assessment of hemoglobin and hematocrit levels. Autologous blood predonation is also a common practice.

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Imaging Studies

Radiography

Multiple authors have cited the value of bending radiographs, including those over a fulcrum.[65] Klepps and Lenke et al found that thoracic fulcrum bending radiographs worked best for them when dealing with isolated main thoracic curves.[66]

The thoracic curve patterns found in adolescent idiopathic scoliosis are still most commonly classified according to the King classification system.[67] Significant questions have been raised regarding the reliability and reproducibility of this system.[68, 69] In addition to this, the King classification alone (in its original form) does not allow comprehensive curve classification (eg, lumbar and thoracolumbar curve patterns).[70] (See the images below.)

Mild juvenile scoliosis. Mild juvenile scoliosis.
Anteroposterior (AP) radiograph shows mild adolesc Anteroposterior (AP) radiograph shows mild adolescent scoliosis.
Lateral view of mild adolescent scoliosis. Lateral view of mild adolescent scoliosis.
Moderate scoliosis. Moderate scoliosis.

Multiple authors have analyzed the ability of orthopedic surgeons to reliably measure scoliosis radiographs. Morrissy et al used 50 radiographs and four examiners (two experienced orthopedic surgeons, one fellow, one senior resident) to study their ability to make Cobb angle measurements. With the examiners choosing end vertebrae and measuring scoliotic curves accordingly, intraobserver variability was 4.9°.[71]

Carman et al used eight scoliosis radiographs measured by five examiners (four orthopedic surgeons, one physical therapist) to evaluate interobserver and intraobserver variation. They found that a 10° measurement difference is necessary before there is a 95% confidence level that one Cobb angle measurement is truly different from another.[72]

Magnetic resonance imaging

Magnetic resonance imaging (MRI) has been suggested to be primarily indicated in patients with idiopathic scoliosis with unusual complaints such as severe unexplained headaches and when clinical findings such as ataxia or cavus feet are present.[73] Routine MRI evaluation of all patients with adolescent idiopathic scoliosis is not recommended.[74]

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Other Tests

Pulmonary function studies have been used extensively in the evaluation of patients with idiopathic scoliosis.[7, 75, 76, 77] In general, patients whose scoliosis surgery does not involve disruption of their chest wall can be expected to experience improved postoperative pulmonary function.[78, 60] Other authors have suggested that an impairment in respiratory mechanics may persist after successful scoliosis surgery.[79] Preoperative pulmonary function testing is of questionable value in patients with moderate deformity (average Cobb angle 48°), as most of these patients can be expected to have normal or only mildly abnormal results.[80]

Efforts at screening for scoliosis (most often in school populations) have met with mixed success. A 2-year evaluation of more than 80,000 Greek 9- to 14-year-old students screened by their schools with the Adams forward-bending test was conducted by Soucacos et al. Overall, they found school screening to be simple and effective. These authors found that they identified 181 new children with scoliosis requiring treatment (11 surgically, 170 with bracing).[81]

Peak height velocity has been studied extensively as a predictor of curve progression.[82]

A small study found that computerized photogrammetry, a novel method for nonradiographic evaluation, exhibited equivalent scoliosis angle measurements in 16 patients compared with the traditional Cobb radiographic method. Although more studies are needed to assess this new tool, it may be a potential new method as a coadjuvant tool in serial monitoring of scoliosis treatment.[83]

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Histologic Findings

Scoliosis is clearly a disease that is strongly influenced by, if not completely rooted in, spinal growth. It has even been referred to by some as "an unsynchronized growth."[84]

Hsu et al from Vanderbilt studied muscle biopsies from 27 patients with idiopathic scoliosis who were undergoing posterior spinal fusion. Specimens were obtained from the paraspinal musculature of both the convex and concave side in all patients. All patients had thoracic curves in the range of 37-81°.[85]

In this study, 68% of the patients demonstrated abnormalities in muscle fiber distribution. The abnormalities were similar on the convex and concave sides, the most notable being a reversal of the normal type 2 fiber ratio, so that type 2A fibers predominated over type 2B fibers in the study subjects. These changes are similar to those seen in endurance training and might be due to the extra work of trying to maintain posture in the setting of scoliosis.[85]

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Contributor Information and Disclosures
Author

Charles T Mehlman, DO, MPH Professor of Pediatrics and Pediatric Orthopedic Surgery, Division of Pediatric Orthopedic Surgery, Director, Musculoskeletal Outcomes Research, Cincinnati Children's Hospital Medical Center

Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, North American Spine Society, Scoliosis Research Society, Cervical Spine Research Society, International Society for the Study of the Lumbar Spine, AOSpine, Society of Lateral Access Surgery, International Society for the Advancement of Spine Surgery, Lumbar Spine Research Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from NuVasive for consulting; Received royalty from Nuvasive for consulting; Received consulting fee from K2M for consulting; Received ownership interest from NuVasive for none.

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Mild juvenile scoliosis.
Anteroposterior (AP) radiograph shows mild adolescent scoliosis.
Lateral view of mild adolescent scoliosis.
Moderate scoliosis.
 
 
 
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