Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis: Diagnosis and Management
Adolescent idiopathic scoliosis is the most common form of scoliosis, affecting

approximately 2% to 4% of adolescents.
The incidence of scoliosis is about the same in males and females; however,
females have up to a 10-fol greater risk of curve progression.
Although most youths with scoliosis will not develop clinical symptoms, scoliosis
can progress to rib deformity and respiratory compromise, and can cause
significant cosmetic problems and emotional distress for some patients.
The goal for primary care physicians is to identify patients who are at risk of
developing problems from scoliosis, without overtesting or overreferring patients
who are unlikely to have further problems.
Treatment options include observation, braces, and surgery.
Etiology
The exact pathophysiologic mechanism for scoliosis is unknown. A genetic factor

has been implicated in the development and progression of scoliosis. If both
parents have idiopathic scoliosis, their children are 50 times more likely to require
scoliosis treatment compared with the general population. It is believed that
scoliosis is a polygenic disorder with multiple inheritance patterns. Saliva-based
genetic markers could be a useful adjunct in predicting which patients are at risk of
scoliosis progression. However, further studies are needed, and genetic testing is
not recommended at this time.
Screening
For decades, scoliosis screenings were a routine part of school physical

examinations in adolescents. The screening itself carries little cost and negligible
risk to the patient
but radiographs and referrals in youths who may be at low risk of disease
progression can lead to significant expense and risk of harm to patients.
It was found fair evidence that treating adolescent idiopathic scoliosis decreases
pain and disability in only a small proportion of patients, and that treatment of
adolescent idiopathic scoliosis detected through screening leads to moderate
harms
Physical Examination
Physical examination for scoliosis mainly consists of the Adams forward bend test
.The patient stands and bends forward at the waist, with the examiner assessing
for symmetry of the back from behind and beside the patient. Patients with possible
scoliosis will have a lateral bending of the spine, but the curve will cause spinal
rotation and eventually a rib hump, which is visible on examination.
This can help avoid imaging in patients with clearly insignificant curves; however,
a Cobb angle measurement using radiography is needed for the official diagnosis
of scoliosis. Generally, an angle of trunk rotation that is less than 5 degrees is
insignificant and may not require follow-up. A measurement of 5 to 9 degrees at
least warrants reexamination in six months. A measurement of 10 degrees or
greater requires radiologic evaluation for Cobb angle measurement.
Red Flags
Although scoliosis is usually benign and rarely requires treatment, there are
several characteristics that suggest more serious problems.
Scoliosis rarely causes significant pain; therefore, severe pain should prompt
evaluation for other possible etiologies. Neurologic disorders should be considered
in patients with neurologic deficits or findings such as midline hairy patches and
caf au lait spots.
Risk Factors for Disease Progression
Three major factors:

Sex
Magnitude of curve on presentation
Growth potential.
Treatment
Determining which patients need referral to an orthopedist can be complicated, and
clear indications are not always available. The risk of spinal curve progression
increases with higher Cobb angle and lower Risser grade. However, the trend in
recent years is that fewer patients need radiography, and fewer patients who
undergo radiography need treatment. Treatment modalities such as physical
therapy, chiropractic care, and electrical stimulation have questionable benefit in
preventing scoliosis progression.
Escoliosis Idioptica Adolescente: Diagnstico y Manejo
La escoliosis idioptica adolescente es la forma ms comn de escoliosis, que

afecta aproximadamente al 2% al 4% de los adolescentes
La incidencia de escoliosis es aproximadamente la misma en varones y mujeres;

Sin embargo, las mujeres tienen hasta un riesgo 10 veces mayor de progresin
de la curva
Aunque la mayora de los jvenes con escoliosis no desarrollaran sntomas

clnicos, la escoliosis puede progresar a la deformidad de las costillas y el
compromiso respiratorio, y puede causar problemas estticos y problemas
emocionales significativos para algunos pacientes.
El objetivo para los mdicos de atencin primaria es identificar a los pacientes que
estn en riesgo de desarrollar problemas de escoliosis, sin sobreevaluar o sobre-
referir a los pacientes que es poco probable que tengan ms problemas
Las opciones de tratamiento incluyen la observacin, los aparatos ortopdicos y la

ciruga.
Etiologa
El mecanismo fisiopatolgico exacto para la escoliosis es desconocido. Un factor
gentico ha sido implicado en el desarrollo y la progresin de la escoliosis. Si
ambos padres tienen escoliosis idioptica, sus hijos son 50 veces ms propensos
a requerir tratamiento de escoliosis en comparacin con la poblacin general. La
escoliosis es Que se cree que es un trastorno polignico con patrones de herencia
mltiples. Los marcadores genticos basados en saliva podran ser un
complemento til para predecir cules pacientes estn en riesgo de progresin de
la escoliosis. Sin embargo, se necesitan ms estudios, y el anlisis gentico no es
Recomendado en este momento.
Cribado
Durante dcadas, los exmenes de escoliosis fueron una parte rutinaria de los
exmenes fsicos escolares en adolescentes. La exploracin en si misma conlleva
poco costo y un riesgo insignificante para el paciente, Pero las radiografas y las
referencias en los jvenes que pueden estar en bajo riesgo de progresin de la
enfermedad pueden llevar a un gasto significativo y el riesgo de dao a los
pacientes.
Se encontr evidencia justa de que el tratamiento de escoliosis idioptica
adolescente disminuye el dolor y la discapacidad en slo una pequea proporcin
de pacientes y que el tratamiento de la escoliosis idioptica adolescente detectado
mediante del cribado conduce a daos moderativos .
Examen fsico
El examen fsico para la escoliosis consiste principalmente en la prueba de flexin

hacia delante de Adam. El paciente se levanta y se inclina hacia adelante en la
cintura, con el examinador evaluando la simetra de la espalda por detrs y al lado
del paciente. Los pacientes con escoliosis posible tendrn una flexin lateral de la
columna vertebral, pero la curva causar la rotacin espinal y, finalmente, una
joroba de costilla, que es visible en el examen.
Esto puede ayudar a evitar imgenes en pacientes con curvas claramente
insignificantes; Sin embargo, se necesita una medida de ngulo de Cobb mediante
radiografa para el diagnstico oficial de escoliosis. Generalmente, un ngulo de
rotacin del tronco menor de 5 grados es insignificante y puede no requerir
seguimiento.4,5 Una medida de 5 a 9 grados por lo menos justifica reexaminar en
seis meses. Una medida de 10 grados o ms requiere una evaluacin radiolgica
para la medicin del ngulo de Cobb,
Banderas rojas
Aunque la escoliosis suele ser benigna y rara vez requiere tratamiento, existen
varias caractersticas que sugieren problemas ms serios
La escoliosis raramente causa dolor significativo; Por lo tanto, el dolor severo
debera dar lugar a la evaluacin de otras posibles etiologas. Los trastornos
neurolgicos deberan considerarse en pacientes con dficits neurolgicos o
hallazgos como manchas peludas de la lnea media y manchas de caf con leche.
Factores de riesgo para la progresin de la enfermedad
Sexo
Magnitud de la curva en la presentacin
Potencial de Crecimiento
Tratamiento
La determinacin de los pacientes que necesitan derivacin a un ortopedista
puede ser complicada y las indicaciones claras no siempre estn disponibles .El
riesgo de progresin de la curva espinal aumenta con el ngulo de Cobb ms alto
y un grado de Risser ms bajo. Sin embargo, la tendencia en los ltimos aos es
que menos pacientes necesitan radiografas y menos pacientes que se someten a
radiografas necesitan tratamiento. Las modalidades de tratamiento como la
terapia fsica, el cuidado quiroprctico y la estimulacin elctrica tienen un
beneficio cuestionable en la prevencin de la progresin de la escoliosis.

Adolescent Idiopathic Scoliosis

Uploaded by

Copyright:

Available Formats

Adolescent Idiopathic Scoliosis

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Adolescent Idiopathic Scoliosis

Uploaded by

Copyright:

Available Formats

Adolescent Idiopathic Scoliosis: Diagnosis and Management

Adolescent idiopathic scoliosis is the most common form of scoliosis, affecting

The exact pathophysiologic mechanism for scoliosis is unknown. A genetic factor

For decades, scoliosis screenings were a routine part of school physical

Risk Factors for Disease Progression

Three major factors:

La escoliosis idioptica adolescente es la forma ms comn de escoliosis, que

La incidencia de escoliosis es aproximadamente la misma en varones y mujeres;

Aunque la mayora de los jvenes con escoliosis no desarrollaran sntomas

Las opciones de tratamiento incluyen la observacin, los aparatos ortopdicos y la

El examen fsico para la escoliosis consiste principalmente en la prueba de flexin

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.