Unit
- Congenital scoliosis: A lateral curvature of the spine caused by vertebral malformations present at birth. These anomalies include hemivertebrae, unilateral bars, and block vertebrae. The curvature may progress rapidly during growth spurts, requiring early monitoring and bracing. Healthcare teams coordinate imaging surveillance to track progression and plan interventions.
- Idiopathic scoliosis: The most common form, with no identifiable cause, typically diagnosed in adolescents aged 10-18. Curves exceeding 25 degrees often require bracing, while those above 45-50 degrees may need surgical correction. Screening programs in schools help with early detection and referral to specialists.
- Neuromuscular scoliosis: Develops secondary to conditions like cerebral palsy, muscular dystrophy, or spinal muscular atrophy. These curves are often long, C-shaped, and frequently progress even after skeletal maturity. Management focuses on maintaining sitting balance, preventing respiratory compromise, and improving quality of life.
- Kyphosis: Excessive forward curvature of the thoracic spine. Scheuermann's kyphosis is the most common pediatric form, presenting with wedge-shaped vertebrae and endplate irregularities. Postural kyphosis is flexible and often correctable with exercises, while structural kyphosis may require bracing or surgery if painful or progressive.
- Spina bifida and tethered cord: Neural tube defects that can affect spinal alignment and function. Occult spina bifida like tethered cord syndrome may present with back pain, leg weakness, or bowel/bladder changes. Multidisciplinary teams address both orthopedic and neurosurgical aspects to preserve neurological function.
- Spondylolysis and spondylolisthesis: Defects in the pars interarticularis, often seen in young athletes involved in hyperextension sports. Spondylolysis is a stress fracture of the pars, while spondylolisthesis involves forward slippage of one vertebra over another. Conservative management includes activity modification and physical therapy.
- Infantile and juvenile scoliosis: Curves appearing before age 3 or between ages 3 and 10. These are less common but have higher risk of progression due to remaining growth potential. Treatment may include casting, bracing, or growth-friendly surgical techniques to allow spinal growth while controlling curvature.
- Spinal infections and tumors: Rare but serious conditions requiring prompt identification. Discitis and vertebral osteomyelitis present with back pain, refusal to walk, and elevated inflammatory markers. Primary spinal tumors like osteoid osteoma or aneurysmal bone cyst can cause painful scoliosis and require imaging to differentiate from benign conditions.
- Chiari malformation and syringomyelia: A Chiari malformation involves herniation of the cerebellar tonsils through the foramen magnum, often associated with a syrinx within the spinal cord. This can produce an atypical left thoracic scoliosis in young children. Diagnosis requires MRI. Neurosurgical decompression may stabilize or improve the curvature, and close orthopedic monitoring is needed.
- Post-laminectomy kyphosis: A progressive sagittal deformity that can develop after multilevel laminectomy in children due to disruption of the posterior tension band and facet joints. Risk is higher in younger patients with immature skeletons. Prevention includes maintaining midline structures or performing concurrent fusion. Treatment often requires posterior spinal fusion with instrumentation.
Terminology
- Cobb angle
- The standard measurement of scoliosis curvature, calculated on standing radiographs by measuring the angle between the most tilted vertebrae above and below the curve apex.
- Risser sign
- An assessment of skeletal maturity based on ossification of the iliac apophysis, ranging from grade 0 (no ossification) to grade 5 (complete fusion).
- Pedicle
- The bony structure connecting the vertebral body to the posterior elements; important for surgical instrumentation and screw placement.
Quick Revision
- Pediatric spine conditions include congenital, idiopathic, and neuromuscular scoliosis, kyphosis, spina bifida, spondylolysis, and infections/tumors.
- Early detection through screening and imaging is essential for timely intervention.
- Treatment ranges from observation and bracing to surgical correction depending on curve magnitude, progression risk, and patient age.
- Understanding disease natural history guides monitoring frequency and family counseling.
Disclaimer
Educational use only. Not intended for practical surgery, incisions, or other surgical procedures. It does not qualify you to perform physical operations.