Scoliosis differential diagnosis

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.

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]

	Symptoms			Physical examination			Imaging
Diseases	Clinical manifestations						Para-clinical findings		Gold standard	Additional findings
	Symptoms			Physical examination			Para-clinical findings
	Atypical Curve	Muscle weakness	Numbness and tingling	Motor and sensory abnormalities	Abnormal reflexes	Babinski sign	X-ray (PA and Lateral view)	M.R.I.
Scoliosis	+	+/-	+/-	+/-	+/-	+/-	Rib or vertebral abnormalities usually seen	Abnormality that may be causing the deformity Spinal cord abnormalities may be seen	MRI	EMG and nerve conduction testing: evidence of upper motor neuron lesions.
Syringomyelia	+	+	+	+	+	+	Rib or vertebral abnormalities may be seen	Abnormality that may be causing the deformity Enlargement of the central canal of the spinal cord	MRI	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	MRI	Swelling on the back Tuft of hair
Arnold-chiari malformation	+/-	+	+	+	+	+	None	Tethered spinal cord Tonsillar herniation	MRI	Headache Absent gag reflex
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.

↑ 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.