Progressive idiopathic early-onset scoliosis can be a life-threatening condition with negative effects on pulmonary function. Scoliosis that develops after 10 is referred to as adolescent idiopathic scoliosis. Screening adolescents without symptoms for scoliosis is of unclear benefit. Definition
Scoliosis is defined as a three-dimensional deviation in the axis of a persons spine. Most instances, including The Scoliosis Research Society, define scoliosis as a Cobb angle of more than 10° to the right or left as the examiner faces the person, i.e. in the coronal plane.Scoliosis has been described as a biomechanical deformity, the progression of which depends on asymmetric forces otherwise known as the Hueter-Volkmann Law. Management
Scoliosis curves do not straighten out on their own. Many children have slight curves that do not need treatment. In these cases, the children grow up to lead normal body posture by itself, even though their small curves never go away. If the patient has a larger curve and they are still growing, it is important to monitor the curve for change by periodic examination and standing x-rays as needed. The rise in spinal abnormalities require examination by an orthopaedic surgeon to determine if active treatment is needed.The traditional medical management of scoliosis is complex and is determined by the severity of the curvature and skeletal maturity, which together help predict the likelihood of progression. The conventional options for children and adolescents are:
Observation
Bracing
Surgery
Physical Therapy.
These defects are caused when the vertebra loses its normal function and is not moving/hypomobile/subluxated. During this time the forces normally distributed by the nucleus pulposus (the incompressible gelatinous center of the intervertebral disc) are concentrated in a certain area causing endplates to deform in a concave manner. Diagnosis
Schmorls nodes can be detected with X-rays, although they can be imaged better by CT or MRI. They are considered to be vertical disc herniations through the cartilaginous vertebral body endplates. Schmorls nodes can sometimes be seen radiographically, however they are more often seen on MRI, even when not visible on plain X-rays. They may or may not be symptomatic, and their etiological significance for back pain is controversial. In a study in Spine by Hamanishi, et al., Schmorls nodes were observed on MRI in 19% of 400 patients with back pain, and in only 9% of an asymptomatic control group. The authors concluded that Schmorls nodes are areas of "vertical disc herniation" through areas of weakness in the endplate. Management
Painful Schmorls node can be diagnosed by discography, which demonstrates an intravertebral disc herniation with concomitant back pain. Surgical treatment should be considered in a patient with persistent disabling back pain. When surgical treatment is indicated, eradication of the intervertebral disc including Schmorls node and segmental fusion are preferable. Eponym
Schmorls nodes are named after German pathologist Christian Georg Schmorl (1861–1932). References
Further reading
Plomp, Kimberly A; Viðarsdóttir, Una Strand; Weston, Darlene A; Dobney, Keith; Collard, Mark (2015).