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Pediatric spinal deformities may occur in isolation, as part of a neuromuscular syndrome, or in association with congenital developmental defects. Whichever form it occurs in, it must be diagnosed as early as possible to prevent progression, cardiopulmonary compromise, and permanent deformity, as well as an unstable and painful spine.
Classification of spinal deformities in children has thus followed several different pathways, ranging from a description of the anatomical curvature with respect to magnitude, number of curves and region of spine affected, to the comprehensive Lenke’s classification, which has good intra- and inter-observer reliability and helps to decide upon the level of fixation required.
However, whichever form it takes, a childhood deformity of the spine requires an early and accurate diagnosis to determine the proper and timely method of correction. This includes a thorough medical history and examination, with imaging procedures to provide a full picture of what is wrong with the spine, as well as accompanying defects, if any, in other organ-systems. This also makes sure that the baseline picture of the spinal deformity is obtained, which will enable further monitoring over the long term.
The signs and symptoms of pediatric spinal deformities vary, but may include any or all of the following:
These may occur in several conditions resulting in pediatric spinal deformity and are therefore non-specific, but suggestive features. They should be followed by a careful and detailed history of the patient, as well as of the family. A physical examination of the body and the whole spine will be performed, and a complete neurological examination to rule out neuromuscular conditions, which could cause scoliosis. Imaging tests will be ordered as indicated.
Imaging tests useful in pediatric spinal deformity include:
Other tests include pulmonary function tests to evaluate the impact of the spinal deformity on the child’s lungs and thoracic cavity, which would help determine the type of intervention needed. Imaging may also be needed to rule out anomalies in the spine, such as diastematomyelia or stenosis. Defects in other organs should also be searched for, using ultrasound to evaluate the heart or the kidneys, and MRI of the central nervous system (CNS) and spinal cord, especially if the deformity is due to a congenital malformation. This is because 30-50% of such cases are associated with neuraxis (i.e. axis of the CNS) anomalies. The latter is sometimes signaled by one of the following:
This type of testing is essential to find any hidden spinal cord pathology in patients with congenital spine anomalies. However, it may be restricted to those with actual focal neurological defect, progression of the spinal deformity, or if needed to plan the surgery.