Scoliosis differential diagnosis: Difference between revisions

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{{CMG}} {{AE}} {{Rohan}}
{{CMG}} {{AE}} {{Rohan}}
==Overview==
==Overview==
Scoliosis must be differentiated from syringomyelia, spina bifida, arnold-chiari malformation and leg length discrepancy.
[[Scoliosis]] must be differentiated from [[syringomyelia]], [[spina bifida]], arnold-chiari malformation and [[leg length discrepancy]].
==Differentiating Scoliosis from other Diseases==
==Differentiating Scoliosis from other Diseases==
*Scoliosis must be differentiated from other diseases that causes  spinal deformity, neurologic abnormalities and gait abnormalities, such as syringomyelia, spina bifida, arnold-chiari malformation and leg length discrepancy.<ref name="pmid28786774">{{cite journal| author=Calloni SF, Huisman TA, Poretti A, Soares BP| title=Back pain and scoliosis in children: When to image, what to consider. | journal=Neuroradiol J | year= 2017 | volume= 30 | issue= 5 | pages= 393-404 | pmid=28786774 | doi=10.1177/1971400917697503 | pmc=5602330 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28786774  }} </ref><ref>Azar, F., Canale, S., Beaty, J. & Campbell, W. (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. Page: 1898-2028.</ref>
*[[Scoliosis]] must be differentiated from other diseases that causes  [[spinal deformity]], [[neurologic]] abnormalities and [[gait]] abnormalities, such as [[syringomyelia]], [[spina bifida]], arnold-chiari malformation and [[leg length discrepancy]].<ref name="pmid28786774">{{cite journal| author=Calloni SF, Huisman TA, Poretti A, Soares BP| title=Back pain and scoliosis in children: When to image, what to consider. | journal=Neuroradiol J | year= 2017 | volume= 30 | issue= 5 | pages= 393-404 | pmid=28786774 | doi=10.1177/1971400917697503 | pmc=5602330 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28786774  }} </ref><ref>Azar, F., Canale, S., Beaty, J. & Campbell, W. (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. Page: 1898-2028.</ref>


===Preferred Table===
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
Line 32: Line 30:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |M.R.I.
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |M.R.I.
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Syringomyelia
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Scoliosis]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* [[Rib]] or [[Vertebra|vertebral]] abnormalities usually seen
| style="background: #F5F5F5; padding: 5px;" |
* Abnormality that may be causing the deformity
* [[Spinal cord]] abnormalities may be seen
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Electromyography|EMG]] and [[Nerve conduction study|nerve conduction]] testing: evidence of [[Upper motor neuron|upper motor neuron lesions]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Syringomyelia]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
Line 40: Line 54:
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Rib or vertebral abnormalities may be seen  
* [[Rib]] or [[Vertebra|vertebral]] abnormalities may be seen  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Abnormality that may be causing the deformity
* Abnormality that may be causing the deformity
* Enlargement of the central canal of the spinal cord
* Enlargement of the [[central canal]] of the [[spinal cord]]
| style="background: #F5F5F5; padding: 5px;" |M.R.I.
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Impaired ambulation and loss of penile erection when syrinx involves lumbosacral area
* Impaired ambulation and loss of penile erection when [[Syrinx (medicine)|syrinx]] involves lumbosacral area
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Spina bifida
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spina bifida]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
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| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Incomplete union of the posterior elements of vertebral levels
* Incomplete union of the posterior elements of [[Vertebra|vertebral]] levels
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Various degrees of failure of neural tube closure
* Various degrees of failure of [[Neural tube defect|neural tube]] closure
* Posterior sac contains meninges and/or spinal cord
* Posterior sac contains [[meninges]] and/or [[spinal cord]]
| style="background: #F5F5F5; padding: 5px;" |M.R.I.
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Swelling on the back
* [[Swelling (medical)|Swelling]] on the back
* Tuft of hair
* Tuft of hair
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Arnold-chiari malformation
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Arnold-chiari malformation
| style="background: #F5F5F5; padding: 5px;" |+/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |None
| style="background: #F5F5F5; padding: 5px;" |None
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Tethered spinal cord
* [[Tethered spinal cord syndrome|Tethered spinal cord]]
* Tonsillar herniation
* [[Brain herniation|Tonsillar herniation]]
| style="background: #F5F5F5; padding: 5px;" |M.R.I.
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Headache
* [[Headache]]
* Absent gag reflex
* Absent [[gag reflex]]
*  
*  
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Atypical curve
! colspan="1" rowspan="1" |Muscle weakness
!Numbness and tingling
!Motor and sensory
abnormalities
! colspan="1" rowspan="1" |Abnormal reflex
!Babinski sign
!X-ray
(PA and Lateral view)
!M.R.I.
|'''Gold standard'''
!Additional findings
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Leg length discrepancy
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leg length discrepancy]]
| style="background: #F5F5F5; padding: 5px;" |+
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Quantify the degree of leg-length discrepancy.
* Quantify the degree of [[Leg length discrepancy|leg-length discrepancy]].
| style="background: #F5F5F5; padding: 5px;" |None
| style="background: #F5F5F5; padding: 5px;" |None
| style="background: #F5F5F5; padding: 5px;" |Orthoroentogram
| style="background: #F5F5F5; padding: 5px;" |Orthoroentogram
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Repeat standing x-rays with the patient standing on a block to account for the discrepancy demonstrates correction of the postural abnormality.
* Repeat standing [[x-rays]] with the patient standing on a block to account for the discrepancy demonstrates correction of the [[Posture|postural]] abnormality.
|}
|}


Latest revision as of 15:24, 10 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Scoliosis must be differentiated from syringomyelia, spina bifida, arnold-chiari malformation and leg length discrepancy.

Differentiating Scoliosis from other Diseases

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Imaging
Atypical Curve Muscle weakness Numbness and tingling Motor and sensory abnormalities Abnormal reflexes Babinski sign X-ray

(PA and Lateral view)

M.R.I.
Scoliosis + +/- +/- +/- +/- +/-
  • Abnormality that may be causing the deformity
  • Spinal cord abnormalities may be seen
 MRI
Syringomyelia + + + + + + MRI
  • Impaired ambulation and loss of penile erection when syrinx involves lumbosacral area
Spina bifida + +/- +/- +/- +/- +/-
  • Incomplete union of the posterior elements of vertebral levels
 MRI
Arnold-chiari malformation +/- + + + + + None MRI
Leg length discrepancy + - - - - - None Orthoroentogram
  • Repeat standing x-rays with the patient standing on a block to account for the discrepancy demonstrates correction of the postural abnormality.

References

  1. ↑ Calloni SF, Huisman TA, Poretti A, Soares BP (2017). "Back pain and scoliosis in children: When to image, what to consider". Neuroradiol J. 30 (5): 393–404. doi:10.1177/1971400917697503. PMC 5602330. PMID 28786774.
  2. ↑ Azar, F., Canale, S., Beaty, J. & Campbell, W. (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. Page: 1898-2028.

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