ARRS Case of the Week- May 15, 2018

NEURORADIOLOGY: Pediatric/Congenital

Case Author: Sumit Pruthi, MBBS, Monroe Carell Jr. Children’s Hospital at Vanderbilt University

History

14-year-old girl with low back pain

Imaging Findings

Posteroanterior radiograph (A) and 3D volume-rendered CT scan (B) of the spine shows moderate right convex thoracolumbar scoliosis and a wedge-shaped vertebral body at thoracolumbar junction.

Diagnosis

Hemivertebral body anomaly (congenital scoliosis)

Teaching Points

Scoliosis is defined as persistent lateral curvature of the spine of more than 10° in the upright or standing position. Although lateral curvature is the main component, it is a complex 3D deformity associated with rotation of the spine and different planes of spinal curvature.

Clinically, spinal curves are subdivided into structural curves and nonstructural curves. Structural curves are those that cannot be corrected with side bending or traction. Nonstructural curves are considered secondary or functional.

Scoliosis has a broad spectrum of manifestations and can be divided into three general categories: congenital, idiopathic, and neuromuscular. Each category has unique clinical and imaging findings and requires different interventions.

Traditionally, idiopathic scoliosis is further divided into three age categories based on the initial presentation of the spinal curvature: infantile (birth–3 years), juvenile (4–10 years), and adolescent (11–17 years).

Infantile scoliosis and juvenile types of scoliosis have a higher rate of associated spinal abnormalities and usually require different imaging and treatment methods compared with those used for adolescent scoliosis.

Adolescent idiopathic scoliosis, a diagnosis of exclusion, is the most common variant of scoliosis and typically affects adolescent girls.

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