Differentials
Congenital scoliosis
Neuromuscular scoliosis
SIGNS / SYMPTOMS
Spinal deformity presenting in a patient with an underlying neurological or muscular disorder that is usually evident by abnormal developmental history or examination findings.
Neurological examination shows motor weakness, spasticity, or difficulties initiating or controlling motor activity, indicative of upper motor neuron lesions.
Gait assessment reveals abnormalities related to muscle weakness or difficulty with initiation and control of motor activity.
INVESTIGATIONS
Electromyogram and nerve conduction testing: evidence of upper motor neuron lesions.
MRI of brain: to evaluate the aetiology of the abnormalities found on physical examination.
Syringomyelia
SIGNS / SYMPTOMS
May present in a very similar manner to adolescent idiopathic scoliosis (AIS).
Earlier onset, with atypical curve patterns and significant curve magnitude at presentation. Subtle neurological abnormalities of asymmetric or hyperreflexive deep tendon reflexes, clonus, a positive Babinski, and abnormal or asymmetric abdominal reflexes.
INVESTIGATIONS
MRI: in patients where there is concern, it is recommended to obtain an MRI of the entire spine to evaluate for an abnormality that may be causing the deformity.
If the abnormality is large enough to be the cause of the patient's presentation/deformity, it should be identifiable on MRI.
Spina bifida
SIGNS / SYMPTOMS
In cases where the condition is severe enough to cause spinal deformity, neurological abnormalities such as sensory and motor deficits corresponding to the level of the deformity usually co-exist.
INVESTIGATIONS
Plain films and advanced imaging modalities (e.g., MRI): to reveal incomplete union of the posterior elements of vertebral levels demonstrating various degrees of failure of neural tube closure.
Arnold-Chiari malformation (tethered spinal cord)
SIGNS / SYMPTOMS
Clinical features range from headaches to identifiable neurological abnormalities such as an abnormal gag reflex and sensory and motor deficits corresponding to the level of the abnormality.
INVESTIGATIONS
MRI of the entire spine: to evaluate for an abnormality that may be causing the deformity, such as a tethered spinal cord or an abnormal position of the hindbrain in relation to the foramen magnum (tonsillar herniation).
Leg-length discrepancy
SIGNS / SYMPTOMS
Results in the development of a compensatory spinal curvature to balance the trunk over the lower extremities.
Examined in both standing and sitting positions. Assessment on sitting allows the pelvis and spine to balance without the influence of the leg-length discrepancy, thus correcting the observed spinal deformity. This would not occur in the presence of scoliosis.
INVESTIGATIONS
Orthoroentgenogram: to quantify the degree of leg-length discrepancy.
After determination of leg-length discrepancy, repeat standing x-rays with the patient standing on a block to account for the discrepancy demonstrates correction of the postural abnormality.
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