Spine Paed

Adolescent idiopathic scoliosis

AIS curve classification, bracing indications, surgical planning and Lenke-type classification.

18 questions 4 source pages

Images appear with the first question taken from each source page — tap a question to open it.

Q1What does the Nash-Moe technique assess?▸

Q2How do you describe the X-ray in AIS?▸

Q3What is the aim of clinical assessment in AIS?▸

Q4What are the key clinical findings on examination in AIS?▸

General: abnormal facial feature, skin change, laxity
Look: convexity of spine, asymmetrical waist line, list/shift/plumb line, shoulder, pelvis level
Sagittal kyphosis assessment
Move: AFB test for hump + scoliometer / side bending
Sit: sitting shoulder level, correctability
Supine: LLD, pelvic obliquity, neurology, abdominal reflex

Q5What imaging is required in AIS?▸

Q6What is the management principle in AIS and how is a progressing curve predicted?▸

Rule out other causes: extra-spinal (LLD, pelvic obliquity) and intra-spinal (congenital, neuromuscular, syndromes - NF, Ehlers-Danlos, Marfan)
Stop progression in slow progress; stop progression + correct deformity in fast progress and severe curve
Predict progressing curve - patient: sex (F>M), skeletal maturity
Predict progressing curve - curve: severity, thoracic > lumbar, double curve, previous progression

Q7What are the treatment options for AIS?▸

Q8What are the indications, principles and complications of bracing in AIS?▸

Q9What are the indications and principle of operative treatment in AIS?▸

Indication: >40 degrees if immature, >50 degrees if mature
Principle: stop progression + correct deformity
Include all structural curves, achieving a solid fusion block with minimal tilting and shift

Q10How is the fusion level chosen and what instrumentation is used in AIS?▸

Level depends on instrumentation, usually referenced to end vertebrae (mildly tilted) or stable vertebrae (vertebrae bisected by the mid-sacral line)
Classical: Luque rod, Harrington rod (cannot control rotation), pedicle screws with rod

Q11What is the progression risk for a Risser 2 patient with a curve of 20-29 degrees?▸

Q12How do treatment and progression risk vary with Risser grade and curve angle?▸

Risser 0-1 (pre-menarche): 10-19 physio (22% curve progression); 20-29 brace (68%); 30-39 brace; 40-49 surgery; >50 surgery
Risser 2-3 (<1 year after menarche): 10-19 physio (2%); 20-29 physio (22%); 30-39 brace; 40-49 ?surgery (for curve >45); >50 surgery
Risser 4-5: physio for 10-19, 20-29, 30-39 and 40-49; >50 surgery

Q13At what curve magnitude does treatment start and when is growth most rapid?▸

Q14What does the PUMC classification include?▸

Q15What does the King classification describe?▸

Q16What does the Lenke classification describe?▸

Number and site of structural curve (6)
Modifiers: central sacral vertical line to lumbar apex, kyphosis
Curve site: proximal thoracic, main thoracic, TLJ/lumbar
Types: main thoracic, double thoracic, double major, triple major, thoracolumbar, thoracolumbar/lumbar + main thoracic

Q17How are curve sites defined in the Lenke classification?▸

Q18What defines a structural curve?▸

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