Scoliosis differential diagnosis: Difference between revisions

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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="3" rowspan="2" |Para-clinical findings
! colspan="2" rowspan="2" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
Line 20: Line 20:
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-  
|-  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Atypical Curve
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Atypical Curve
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Muscle weakness
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Muscle weakness
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Numbness and tingling
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Numbness and tingling
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Motor and sensory anormalities
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Motor and sensory abnormalities
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal reflexes
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal reflexes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Babinski sign
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Babinski sign
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |X-ray
(PA and Lateral view of spine)
(PA and Lateral view)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |M.R.I.
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |M.R.I.
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Syringomyelia
| 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;" | +
| 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;" |
* Rib or vertebral abnormalities may be
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Abnormality that may be causing the deformity.
* Rib or vertebral abnormalities may be seen
* Enlargement of the central canal of the spinal cord.
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Abnormality that may be causing the deformity
* Enlargement of the central canal of the spinal cord
| style="background: #F5F5F5; padding: 5px;" |M.R.I.
| style="background: #F5F5F5; padding: 5px;" |M.R.I.
| 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 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;" | +/-
| 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;" |
* Incomplete union of the posterior elements of vertebral levels
* Incomplete union of the posterior elements of 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 closure
* Posterior sac contains meninges and/or spinal cord.
* Posterior sac contains meninges and/or spinal cord
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |M.R.I.
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Swelling on the back.
* 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;" |None
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Tethered spinal cord
* Tonsillar herniation
| style="background: #F5F5F5; padding: 5px;" |M.R.I.
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Headache
| style="background: #F5F5F5; padding: 5px;" |
* Absent gag reflex
| 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: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Diseases
!Symptom 1
!Atypical curve
! colspan="1" rowspan="1" |Symptom 2
! colspan="1" rowspan="1" |Muscle weakness
!Symptom 3
!Numbness and tingling
!Physical exam 1
!Motor and sensory
! colspan="1" rowspan="1" |Physical exam 2
abnormalities
!Physical exam 3
! colspan="1" rowspan="1" |Abnormal reflex
!Imaging 1
!Babinski sign
!Imaging 2
!X-ray
!Imaging 3
(PA and Lateral view)
!M.R.I.
|'''Gold standard'''
|'''Gold standard'''
!Additional findings
!Additional findings
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| 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;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| 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: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
| 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.
| style="background: #F5F5F5; padding: 5px;" |None
| 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.
|}
|}


Revision as of 16:18, 30 November 2018

Scoliosis Microchapters

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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

  • 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.[1][2]


Preferred Table

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.
Syringomyelia + + + + + +
  • Rib or vertebral abnormalities may be seen
  • Abnormality that may be causing the deformity
  • Enlargement of the central canal of the spinal cord
 M.R.I.
  • Impaired ambulation and loss of penile erection when syrinx involves lumbosacral area
Spina bifida + +/- +/- +/- +/- +/-
  • Incomplete union of the posterior elements of vertebral levels
  • Various degrees of failure of neural tube closure
  • Posterior sac contains meninges and/or spinal cord
 M.R.I.
  • Swelling on the back
  • Tuft of hair
Arnold-chiari malformation +/- + + + + + None
  • Tethered spinal cord
  • Tonsillar herniation
 M.R.I.
  • Headache
  • Absent gag reflex
Diseases Atypical curve Muscle weakness Numbness and tingling Motor and sensory

abnormalities

Abnormal reflex Babinski sign X-ray

(PA and Lateral view)

M.R.I. Gold standard Additional findings
Leg length discrepancy + - - - - -
  • Quantify the degree of 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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