Back: Paediatric Spinal Deformity

Two structural spinal deformities of adolescence — scoliosis (coronal-plane curvature) and Scheuermann disease (sagittal-plane kyphosis).

Adolescent idiopathic scoliosis

• Demographics: adolescent females, from ~age 10.
• History: often asymptomatic — usually picked up on screening or incidentally.
• Examination: the forward bend (Adams) test — have the patient bend forward as far as possible and look along the spine for asymmetric rib/ shoulder-blade prominence.

• Investigations: X-ray — measure the Cobb angle.

Management by Cobb angle:

Still growing	Growth complete
<20° — observe	<45° — leave
20–30° — optional brace	≥45° — operate
30–40° — brace
>45° — operate

Scheuermann disease

Adolescent structural thoracic kyphosis from anterior vertebral wedging. See also thoracic back pain (approach).

• Demographics: age 11–17; males > females.
• History: increasing thoracic kyphosis over 1–2 months.
• Examination: noticeable thoracic kyphosis; short hamstrings — cannot touch toes.
• Investigations: X-ray shows Schmorl’s nodes and anterior vertebral body wedging.
• Management:
  • extension exercises and postural correction
  • avoid sports involving heavy lifting or bending
  • bracing or surgery for serious deformity.