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Scoliosis
Christopher G. Anton, MD
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KEY FACTS

  • Terminology

    • Clinical Issues

      TERMINOLOGY

      • Synonyms

        • Idiopathic scoliosis, neuromuscular scoliosis, congenital scoliosis
      • Definitions

        • Presence of lateral curvature(s) of spine with Cobb angle of ≥ 10°, often associated with vertebral rotation
        • 2 types
          • Flexible: Nonstructural, corrects with ipsilateral bending, usually does not progress
          • Structural: Rigid, does not demonstrate correction with ipsilateral bending
            • Cobb angle remains ≥ 25° on ipsilateral bending

      IMAGING

      • General Features

        • Radiographic Findings

          • CT Findings

            • MR Findings

              • Ultrasonographic Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. de Oliveira RG et al: Magnetic resonance imaging effectiveness in adolescent idiopathic scoliosis. Spine Deform. 9(1):67-73, 2021
                                    2. Erkilinc M et al: Postoperative correction in idiopathic scoliosis: which preoperative imaging technique is most predictive? J Pediatr Orthop. 41(9):e706-11, 2021
                                    3. Guglielmi R et al: Preoperative and postoperative imaging in idiopathic scoliosis: what the surgeon wants to know. Semin Musculoskelet Radiol. 25(1):155-66, 2021
                                    4. Jarrett DY et al: EOS imaging of scoliosis, leg length discrepancy and alignment. Semin Roentgenol. 56(3):228-44, 2021
                                    5. Lee TT et al: 3D ultrasound imaging provides reliable angle measurement with validity comparable to x-ray in patients with adolescent idiopathic scoliosis. J Orthop Translat. 29:51-9, 2021
                                    6. Pang H et al: Using ultrasound to screen for scoliosis to reduce unnecessary radiographic radiation: a prospective diagnostic accuracy study on 442 schoolchildren. Ultrasound Med Biol. 47(9):2598-607, 2021
                                    7. Pasha S et al: Quantitative imaging of the spine in adolescent idiopathic scoliosis: shifting the paradigm from diagnostic to comprehensive prognostic evaluation. Eur J Orthop Surg Traumatol. 31(7):1273-85, 2021
                                    8. Ruffilli A et al: Does use of pre-operative low-dose CT-scan in adolescent idiopathic scoliosis improve accuracy in screw placement? Results of a retrospective study. Spine Deform. 9(5):1403-10, 2021
                                    9. Chen J et al: Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases. BMC Neurol. 20(1):433, 2020
                                    10. El-Hawary R et al: VEPTR treatment of early onset scoliosis in children without rib abnormalities: long-term results of a prospective, multicenter study. J Pediatr Orthop. 40(6):e406-12, 2020
                                    11. Girdler S et al: Emerging techniques in diagnostic imaging for idiopathic scoliosis in children and adolescents: a review of the literature. World Neurosurg. 136:128-35, 2020
                                    12. Qiu C et al: Patient-reported outcomes are equivalent in patients who receive vertebral body tethering versus posterior spinal fusion in adolescent idiopathic scoliosis. Orthopedics. 1-5, 2020
                                    13. Mackel CE et al: A comprehensive review of the diagnosis and management of congenital scoliosis. Childs Nerv Syst. 34(11):2155-71, 2018
                                    14. Tully PA et al: Should all paediatric patients with presumed idiopathic scoliosis undergo MRI screening for neuro-axial disease? Childs Nerv Syst. 34(11):2173-8, 2018
                                    15. Cheung JP et al: Clinical utility of ultrasound to prospectively monitor distraction of magnetically controlled growing rods. Spine J. 16(2):204-9, 2016
                                    16. Hirsch C et al: Flexibility analysis in adolescent idiopathic scoliosis on side-bending images using the EOS imaging system. Orthop Traumatol Surg Res. 102(4):495-500, 2016
                                    17. Melhem E et al: EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop. 10(1):1-14, 2016
                                    18. Wang Q et al: Validity study of vertebral rotation measurement using 3-D ultrasound in adolescent idiopathic scoliosis. Ultrasound Med Biol. 42(7):1473-81, 2016
                                    19. Zhang W et al: The prevalence of intraspinal anomalies in infantile and juvenile patients with "presumed idiopathic" scoliosis: a MRI-based analysis of 504 patients. BMC Musculoskelet Disord. 17(1):189, 2016
                                    20. Kim H et al: Scoliosis imaging: what radiologists should know. Radiographics. 30(7):1823-42, 2010
                                    21. Inoue M et al: Preoperative MRI analysis of patients with idiopathic scoliosis: a prospective study. Spine (Phila Pa 1976). 30(1):108-14, 2005
                                    22. Richards BS et al: Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976). 30(18):2068-75; discussion 2076-7, 2005
                                    23. Hedequist D et al: Congenital scoliosis. J Am Acad Orthop Surg. 12(4):266-75, 2004
                                    24. Christodoulou A et al: Idiopathic scoliosis. Segmental fusion with transpedicular screws. Stud Health Technol Inform. 91:433-7, 2002
                                    25. Goldberg CJ et al: The natural history of early onset scoliosis. Stud Health Technol Inform. 91:68-70, 2002
                                    26. Vitale MG et al: Orthopaedic manifestations of neurofibromatosis in children: an update. Clin Orthop Relat Res. (401):107-18, 2002
                                    27. Mohanty S et al: Patterns of presentation of congenital scoliosis. J Orthop Surg (Hong Kong). 8(2):33-7, 2000
                                    28. Nokes SR et al: Childhood scoliosis: MR imaging. Radiology. 164(3):791-7, 1987
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Clinical Issues

                                        TERMINOLOGY

                                        • Synonyms

                                          • Idiopathic scoliosis, neuromuscular scoliosis, congenital scoliosis
                                        • Definitions

                                          • Presence of lateral curvature(s) of spine with Cobb angle of ≥ 10°, often associated with vertebral rotation
                                          • 2 types
                                            • Flexible: Nonstructural, corrects with ipsilateral bending, usually does not progress
                                            • Structural: Rigid, does not demonstrate correction with ipsilateral bending
                                              • Cobb angle remains ≥ 25° on ipsilateral bending

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • CT Findings

                                              • MR Findings

                                                • Ultrasonographic Findings

                                                  • Nuclear Medicine Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. de Oliveira RG et al: Magnetic resonance imaging effectiveness in adolescent idiopathic scoliosis. Spine Deform. 9(1):67-73, 2021
                                                                      2. Erkilinc M et al: Postoperative correction in idiopathic scoliosis: which preoperative imaging technique is most predictive? J Pediatr Orthop. 41(9):e706-11, 2021
                                                                      3. Guglielmi R et al: Preoperative and postoperative imaging in idiopathic scoliosis: what the surgeon wants to know. Semin Musculoskelet Radiol. 25(1):155-66, 2021
                                                                      4. Jarrett DY et al: EOS imaging of scoliosis, leg length discrepancy and alignment. Semin Roentgenol. 56(3):228-44, 2021
                                                                      5. Lee TT et al: 3D ultrasound imaging provides reliable angle measurement with validity comparable to x-ray in patients with adolescent idiopathic scoliosis. J Orthop Translat. 29:51-9, 2021
                                                                      6. Pang H et al: Using ultrasound to screen for scoliosis to reduce unnecessary radiographic radiation: a prospective diagnostic accuracy study on 442 schoolchildren. Ultrasound Med Biol. 47(9):2598-607, 2021
                                                                      7. Pasha S et al: Quantitative imaging of the spine in adolescent idiopathic scoliosis: shifting the paradigm from diagnostic to comprehensive prognostic evaluation. Eur J Orthop Surg Traumatol. 31(7):1273-85, 2021
                                                                      8. Ruffilli A et al: Does use of pre-operative low-dose CT-scan in adolescent idiopathic scoliosis improve accuracy in screw placement? Results of a retrospective study. Spine Deform. 9(5):1403-10, 2021
                                                                      9. Chen J et al: Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases. BMC Neurol. 20(1):433, 2020
                                                                      10. El-Hawary R et al: VEPTR treatment of early onset scoliosis in children without rib abnormalities: long-term results of a prospective, multicenter study. J Pediatr Orthop. 40(6):e406-12, 2020
                                                                      11. Girdler S et al: Emerging techniques in diagnostic imaging for idiopathic scoliosis in children and adolescents: a review of the literature. World Neurosurg. 136:128-35, 2020
                                                                      12. Qiu C et al: Patient-reported outcomes are equivalent in patients who receive vertebral body tethering versus posterior spinal fusion in adolescent idiopathic scoliosis. Orthopedics. 1-5, 2020
                                                                      13. Mackel CE et al: A comprehensive review of the diagnosis and management of congenital scoliosis. Childs Nerv Syst. 34(11):2155-71, 2018
                                                                      14. Tully PA et al: Should all paediatric patients with presumed idiopathic scoliosis undergo MRI screening for neuro-axial disease? Childs Nerv Syst. 34(11):2173-8, 2018
                                                                      15. Cheung JP et al: Clinical utility of ultrasound to prospectively monitor distraction of magnetically controlled growing rods. Spine J. 16(2):204-9, 2016
                                                                      16. Hirsch C et al: Flexibility analysis in adolescent idiopathic scoliosis on side-bending images using the EOS imaging system. Orthop Traumatol Surg Res. 102(4):495-500, 2016
                                                                      17. Melhem E et al: EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop. 10(1):1-14, 2016
                                                                      18. Wang Q et al: Validity study of vertebral rotation measurement using 3-D ultrasound in adolescent idiopathic scoliosis. Ultrasound Med Biol. 42(7):1473-81, 2016
                                                                      19. Zhang W et al: The prevalence of intraspinal anomalies in infantile and juvenile patients with "presumed idiopathic" scoliosis: a MRI-based analysis of 504 patients. BMC Musculoskelet Disord. 17(1):189, 2016
                                                                      20. Kim H et al: Scoliosis imaging: what radiologists should know. Radiographics. 30(7):1823-42, 2010
                                                                      21. Inoue M et al: Preoperative MRI analysis of patients with idiopathic scoliosis: a prospective study. Spine (Phila Pa 1976). 30(1):108-14, 2005
                                                                      22. Richards BS et al: Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976). 30(18):2068-75; discussion 2076-7, 2005
                                                                      23. Hedequist D et al: Congenital scoliosis. J Am Acad Orthop Surg. 12(4):266-75, 2004
                                                                      24. Christodoulou A et al: Idiopathic scoliosis. Segmental fusion with transpedicular screws. Stud Health Technol Inform. 91:433-7, 2002
                                                                      25. Goldberg CJ et al: The natural history of early onset scoliosis. Stud Health Technol Inform. 91:68-70, 2002
                                                                      26. Vitale MG et al: Orthopaedic manifestations of neurofibromatosis in children: an update. Clin Orthop Relat Res. (401):107-18, 2002
                                                                      27. Mohanty S et al: Patterns of presentation of congenital scoliosis. J Orthop Surg (Hong Kong). 8(2):33-7, 2000
                                                                      28. Nokes SR et al: Childhood scoliosis: MR imaging. Radiology. 164(3):791-7, 1987