Unusual Case of Secondary Scoliosis in a 20-Year-Old Man

Abstract not available. Introduction provided instead.

Secondary, or sciatic, scoliosis is a reactive spinal deformity caused by an underlying pain source. Sciatic scoliosis is 1 of 3 scoliosis subtypes first described in 1980 by McPhee and O’Brien.¹ The other 2 subtypes are idiopathic scoliosis and structural defect. In most cases, children and adolescents presenting with idiopathic scoliotic curves have no pain.² In contrast, secondary scoliosis usually has a pain component and can occur with disc herniation, spondylolisthesis, and osteoid osteoma. Secondary scoliosis presents as a continuum of physical and radiographic findings. Patients affected by secondary scoliosis are often pediatric patients and have a clearly demonstrable painful lesion. In some cases, however, the pain source is unclear. This de novo spinal deformity begins as a nonstructural type of scoliosis secondary to a painful focus, which is readily reversible with treatment of the painful lesion. Residual structural scoliosis curves may occur, particularly when there is a long delay between diagnosis and treatment. Signs and symptoms of disc herniation in adolescents and children may develop slowly and insidiously. The clinical presentation differs from the typical picture in the adult population, but the transition point is not precise from adolescent to adult. Adults may bend, list, or tilt in response to pain but seldom have nonstructural scoliosis. In this report, we present a case that reinforces the importance of serial examination and follow-up even in the absence of neurologic findings or an overt pain source. A review of the literature on epidemiology, pathophysiology, and management is included.