Scoliosis diagnostic study of choice: Difference between revisions
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{{CMG}}; {{AE}} {{Rohan}} | {{CMG}}; {{AE}} {{Rohan}} | ||
== Overview == | == Overview == | ||
[[Magnetic resonance imaging|MRI]] (magnetic resonance imaging) is the gold standard test for the diagnosis of [[scoliosis]]. In addition, [[x-rays]] and [[Computed tomography|CT scan]] of the [[spine]] must be performed to monitor curve progression and look for [[Vertebra|vertebral]] anomalies. | |||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
=== Study of choice === | === Study of choice === | ||
* | * [[Magnetic resonance imaging|MRI(magnetic resonance imaging)]] is the gold standard test for the diagnosis of [[scoliosis]].<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><ref name="pmid21178850">{{cite journal| author=Diab M, Landman Z, Lubicky J, Dormans J, Erickson M, Richards BS et al.| title=Use and outcome of MRI in the surgical treatment of adolescent idiopathic scoliosis. | journal=Spine (Phila Pa 1976) | year= 2011 | volume= 36 | issue= 8 | pages= 667-71 | pmid=21178850 | doi=10.1097/BRS.0b013e3181da218c | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21178850 }} </ref> | ||
* In addition, x-rays of the spine must be performed when:<ref name="pmid27811503">{{cite journal| author=Hong A, Jaswal N, Westover L, Parent EC, Moreau M, Hedden D et al.| title=Surface Topography Classification Trees for Assessing Severity and Monitoring Progression in Adolescent Idiopathic Scoliosis. | journal=Spine (Phila Pa 1976) | year= 2017 | volume= 42 | issue= 13 | pages= E781-E787 | pmid=27811503 | doi=10.1097/BRS.0000000000001971 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27811503 }} </ref> | * In addition, [[x-rays]] of the [[spine]] must be performed when:<ref name="pmid27811503">{{cite journal| author=Hong A, Jaswal N, Westover L, Parent EC, Moreau M, Hedden D et al.| title=Surface Topography Classification Trees for Assessing Severity and Monitoring Progression in Adolescent Idiopathic Scoliosis. | journal=Spine (Phila Pa 1976) | year= 2017 | volume= 42 | issue= 13 | pages= E781-E787 | pmid=27811503 | doi=10.1097/BRS.0000000000001971 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27811503 }} </ref> | ||
* The patient presents with atypical curve, low back pain, stiffness, and abnormal posture. | * The patient presents with atypical curve, low [[back pain]], [[stiffness]], and abnormal [[posture]]. | ||
* X-rays also help in monitoring the progression of the curve. | * [[X-rays]] also help in monitoring the progression of the curve. | ||
==== The comparison of various diagnostic studies for scoliosis ==== | ==== The comparison of various diagnostic studies for scoliosis ==== | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity | ||
|- | |- | ||
! style="background: #696969; color: #FFFFFF; text-align: center;" | | ! style="background: #696969; color: #FFFFFF; text-align: center;" |MRI | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |94.4% | | style="background: #DCDCDC; padding: 5px; text-align: center;" |94.4% | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |95.5% | | style="background: #DCDCDC; padding: 5px; text-align: center;" |95.5% | ||
| Line 27: | Line 27: | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |35% | | style="background: #DCDCDC; padding: 5px; text-align: center;" |35% | ||
|} | |} | ||
<small> Thus | <small> Thus [[Magnetic resonance imaging|MRI]] is the preferred investigation based on the sensitivity and specificity</small> | ||
===== Diagnostic results ===== | ===== Diagnostic results ===== | ||
The following finding(s) on performing | The following finding(s) on performing [[Magnetic resonance imaging|MRI]] are confirmatory for scoliosis: | ||
* Abnormality that may be causing the deformity such as hemivertebra, wedge vertebra, and bilamina.<ref name="pmid27811503">{{cite journal| author=Hong A, Jaswal N, Westover L, Parent EC, Moreau M, Hedden D et al.| title=Surface Topography Classification Trees for Assessing Severity and Monitoring Progression in Adolescent Idiopathic Scoliosis. | journal=Spine (Phila Pa 1976) | year= 2017 | volume= 42 | issue= 13 | pages= E781-E787 | pmid=27811503 | doi=10.1097/BRS.0000000000001971 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27811503 }} </ref><ref>{{cite journal |last1=Imagama |first1=S |last2=Kawakami |first2=N |date=2005 |title=Spatial relationships between a deformed vertebra and an adjacent vertebra in congenial scoliosis-failure of formation. |url= |journal=J Jpn Scoliosis Soc. |volume=20 |issue= |pages=20-25 |doi= |pmc= |pmid= |access-date= | name-list-format=vanc }}</ref> | * Abnormality that may be causing the deformity such as hemivertebra, wedge [[vertebra]], and bilamina.<ref name="pmid27811503">{{cite journal| author=Hong A, Jaswal N, Westover L, Parent EC, Moreau M, Hedden D et al.| title=Surface Topography Classification Trees for Assessing Severity and Monitoring Progression in Adolescent Idiopathic Scoliosis. | journal=Spine (Phila Pa 1976) | year= 2017 | volume= 42 | issue= 13 | pages= E781-E787 | pmid=27811503 | doi=10.1097/BRS.0000000000001971 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27811503 }} </ref><ref>{{cite journal |last1=Imagama |first1=S |last2=Kawakami |first2=N |date=2005 |title=Spatial relationships between a deformed vertebra and an adjacent vertebra in congenial scoliosis-failure of formation. |url= |journal=J Jpn Scoliosis Soc. |volume=20 |issue= |pages=20-25 |doi= |pmc= |pmid= |access-date= | name-list-format=vanc }}</ref> | ||
* Spinal cord abnormalities such as syringomyelia, tonsillar herniation, and meningomyelocoele.<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> | * [[Spinal cord]] abnormalities such as [[syringomyelia]], [[tonsillar herniation]], and [[meningomyelocoele]].<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> | ||
===== Sequence of Diagnostic Studies ===== | ===== Sequence of Diagnostic Studies ===== | ||
The various investigations must be performed in the following order: | The various investigations must be performed in the following order: | ||
* X-rays of spine | * [[X-rays]] of spine | ||
* | *[[CT scan]] | ||
* [[Magnetic resonance imaging|MRI]] | |||
* | |||
=== Scoliosis Diagnostic Criteria === | |||
Based on literature, [[scoliosis]] may be diagnosed at any time if one or more of the following rule in criteria are met:<ref name="pmid19030463">{{cite journal| author=Janicki JA, Alman B| title=Scoliosis: Review of diagnosis and treatment. | journal=Paediatr Child Health | year= 2007 | volume= 12 | issue= 9 | pages= 771-6 | pmid=19030463 | doi= | pmc=2532872 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19030463 }} </ref> <ref name="pmid9306532">{{cite journal| author=Kesling KL, Reinker KA| title=Scoliosis in twins. A meta-analysis of the literature and report of six cases. | journal=Spine (Phila Pa 1976) | year= 1997 | volume= 22 | issue= 17 | pages= 2009-14; discussion 2015 | pmid=9306532 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9306532 }} </ref><ref name="pmid15948477">{{cite journal| author=Parent S, Newton PO, Wenger DR| title=Adolescent idiopathic scoliosis: etiology, anatomy, natural history, and bracing. | journal=Instr Course Lect | year= 2005 | volume= 54 | issue= | pages= 529-36 | pmid=15948477 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15948477 }} </ref> | |||
* Scoliometer measurement of >5° | |||
* Cobb angle measurement, of a major structural curve, of >10° (cut-off based on natural history studies and evaluation of curve progression rates) | |||
* Absence of other possible cause for the [[spinal deformity]]. | |||
==References== | ==References== | ||
Latest revision as of 16:03, 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
MRI (magnetic resonance imaging) is the gold standard test for the diagnosis of scoliosis. In addition, x-rays and CT scan of the spine must be performed to monitor curve progression and look for vertebral anomalies.
Diagnostic Study of Choice
Study of choice
- MRI(magnetic resonance imaging) is the gold standard test for the diagnosis of scoliosis.[1][2][3]
- In addition, x-rays of the spine must be performed when:[4]
- The patient presents with atypical curve, low back pain, stiffness, and abnormal posture.
- X-rays also help in monitoring the progression of the curve.
The comparison of various diagnostic studies for scoliosis
| Test | Sensitivity | Specificity |
|---|---|---|
| MRI | 94.4% | 95.5% |
| X-ray | 95% | 35% |
Thus MRI is the preferred investigation based on the sensitivity and specificity
Diagnostic results
The following finding(s) on performing MRI are confirmatory for scoliosis:
- Abnormality that may be causing the deformity such as hemivertebra, wedge vertebra, and bilamina.[4][5]
- Spinal cord abnormalities such as syringomyelia, tonsillar herniation, and meningomyelocoele.[1]
Sequence of Diagnostic Studies
The various investigations must be performed in the following order:
Scoliosis Diagnostic Criteria
Based on literature, scoliosis may be diagnosed at any time if one or more of the following rule in criteria are met:[6] [7][8]
- Scoliometer measurement of >5°
- Cobb angle measurement, of a major structural curve, of >10° (cut-off based on natural history studies and evaluation of curve progression rates)
- Absence of other possible cause for the spinal deformity.
References
- ↑ 1.0 1.1 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.
- ↑ Azar, F., Canale, S., Beaty, J. & Campbell, W. (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. Page: 1898-2028.
- ↑ Diab M, Landman Z, Lubicky J, Dormans J, Erickson M, Richards BS; et al. (2011). "Use and outcome of MRI in the surgical treatment of adolescent idiopathic scoliosis". Spine (Phila Pa 1976). 36 (8): 667–71. doi:10.1097/BRS.0b013e3181da218c. PMID 21178850.
- ↑ 4.0 4.1 Hong A, Jaswal N, Westover L, Parent EC, Moreau M, Hedden D; et al. (2017). "Surface Topography Classification Trees for Assessing Severity and Monitoring Progression in Adolescent Idiopathic Scoliosis". Spine (Phila Pa 1976). 42 (13): E781–E787. doi:10.1097/BRS.0000000000001971. PMID 27811503.
- ↑ Imagama S, Kawakami N (2005). "Spatial relationships between a deformed vertebra and an adjacent vertebra in congenial scoliosis-failure of formation". J Jpn Scoliosis Soc. 20: 20–25.
- ↑ Janicki JA, Alman B (2007). "Scoliosis: Review of diagnosis and treatment". Paediatr Child Health. 12 (9): 771–6. PMC 2532872. PMID 19030463.
- ↑ Kesling KL, Reinker KA (1997). "Scoliosis in twins. A meta-analysis of the literature and report of six cases". Spine (Phila Pa 1976). 22 (17): 2009–14, discussion 2015. PMID 9306532.
- ↑ Parent S, Newton PO, Wenger DR (2005). "Adolescent idiopathic scoliosis: etiology, anatomy, natural history, and bracing". Instr Course Lect. 54: 529–36. PMID 15948477.