gms | German Medical Science

Objectives: Idiopathic scoliosis must be differentiated from non-idiopathic scoliosis, which is caused by intraspinal and extraspinal pathologies. This is important, because the outcome of scoliosis brace treatment is influenced by the underlying disorder.

A modifed brace treatment is indicated for non-idiopathic scoliosis to optimize outcome. A thorough differential history and MRI of the spine should increase the diagnosed number of non-idiopathic scoliosis. This study presents the results of a prospective protocol to identify as many non-idiopathic scoliosis as possible and identify the underlying disorder.

Methods: In this study, 105 patients with scoliosis were examined after exclusion of obvious neurological diseases in a five months period in the year 2020. All patients underwent the same examination protocol, which was established before this period. After spine radiography, patients with a Cobb angle > 10° and lumbar or cervicothoracic curves were included and offered MRI. Scoliosis-related diagnoses were divided into intraspinal and extraspinal disorders.

Results and conclusion: In the current study 26,5% (n=35) of patients were diagnosed with an idiopathic scoliosis and 70 with a non-idiopathic scoliosis (73,5%).

In the idiopathic group, there were no infantile, 11 juvenile, and 25 adolescent scoliosis; in the non-idiopathic group, there were 4 infantile, 32 juvenile, and 34 adolescent scoliosis. In the idiopathic scoliosis group, the Cobb angle was less than 20° in 7 patients, and in the non-idiopathic group in 27. The Cobb angle was between 21° and 45° in 25 idiopathic (>45° in 3) and 39 in the non-idiopathic (>45° in 5). Furthermore, juvenile scoliosis is only in 25% idiopathic (11 patients out of 35 compared to 32 patients out of 70). AThe Risser's sign was >2 in 4 of 25 patients in the idiopathic group and in 10 of 34 patients in the non-idiopathic group.

In the non-idiopathic scoliosis group 27 (38,6%) had intraspinal and 43 (61,4%) had extraspinal disorders which are assumed cause of scoliosis.

Intraspinal disorders (n=27): the most common cause of non-idiopathic scoliosis with intraspinal disorder is malformation. 11.1% (n=3) showed a complex malformation. Lumbosacral transition vertebra (Castellvi II-IV) accounted for 40.1% (n=11). Lumbalisation was found in 1 case, Spondylolisthesis could be found in 18.8% (n=4) of patients. Syringomyelia was diagnosed in 18.5% (n=5) patients. Intraspinal malformation (tumor, spinal root and arachnoidal cyst, two of them had surgery) was diagnosed in 11,1% (n=3).

Extraspinal disorders (n=43): in 60.5% (n=26) of patients a syndrome could be identified as the most probable. Other causes include, hemiatropia, length difference, plexus paresis, thoracic surgery in early childhood (n=6) or others.

A detailed history and MRI scan are critical to the diagnosis of scoliosis. The availability of MRI increases the number of non-idiopathic (symptomatic) scoliosis. Consequently, the results are important for the indication and goal of brace treatment.