Acute Onset Atypical Severe Scoliosis: A Case Report.

Background: Although most cases of scoliosis are idiopathic, scoliosis may also be congenital or associated with other diseases. Herniated Nucleus Pulposus (HNP) has been reported as a potential cause of non-structural scoliosis. HNP is unusual in adolescents and the clinical features are typically different from those in adults. Case Presentation: An 18-year-old Caucasian male was referred to our ambulatory service for evaluation of scoliosis after orthopedic evaluation at another center. He had noticed left-sided low back pain in the previous 6 months, which had worsened over the last two months with the development of limp and left lower extremity (LLE) paresthesias. After an accurate clinical evaluation, the acute onset of the curvature with mild back pain and associated neurological findings were suggestive of an intraspinal lesion. The MRI examination showed an L4-L5 HNP compressing L4 nerve root and displacing the distal L5 nerve root. An L4-L5 laminectomy and discectomy were performed. His left leg pain was completely relieved the day after surgery. At 3 months follow-up complete resolution of scoliosis deformity and return to full activity was achieved. Conclusions: Every child who presents with atypical scoliosis should have a complete physical examination and appropriate imaging studies seeking an underlying cause.