Early diagnosis and treatment helps to prevent curve progression and deformity. Scoliosis left untreated may progress, leaving the spine abnormally curved, stiff, and sometimes rigid. This makes treatment difficult and increases the risks for serious complications.

 

Medical and Family History is the first step in Scoliosis Diagnosis:

 

The patient, parents, and physician discuss the medical and family history. The physician looks for any underlying medical condition that might be causing scoliosis. A family history of the disease or other attributing medical disorders is noted.

 

The patient's age, onset of puberty, or menarche (girls) helps to determine the number of years remaining until the child reaches adulthood, at which time curve progression may cease.

 

Physical Examination

 

A thorough physical examination reveals a lot about the health and general fitness of the patient. The exam provides a baseline from which the physician can measure the patient's progress during treatment. The physician will observe the patient standing (front and back) and look for any asymmetric abnormalities in the shoulders, rib cage, waist, and pelvis.

 

Patients with scoliosis may present humpback, one hip higher than the other, or listing to one side.   In severe scoliosis, cardiopulmonary (heart/lung) function is tested. The physical examination also includes:

 

• Adam's Forward Bending Test requires the patient to bend forward at the waist. Viewed posteriorly (from behind), scoliosis is suspected if a thoracic (mid-back) or lumbar (lower back) prominence is apparent.

• A rib hump can be measured in degrees using a Scoliometer. While the patient is bent at the waist, the scoliometer is placed over the rib hump.

• Leg length is measured and compared to determine discrepancy.

• A plumb line held posteriorly at the 7th cervical vertebra (C7) is allowed to hang below the buttocks. In a normal spine, the line passes through the gluteal crease (middle of buttocks). In scoliosis, the scoliotic portions of the spine may fall to the right or left of the line.

• Palpation determines spinal abnormalities by feel. The ribs (thoracic) or lumbar muscles may feel more prominent on one side of the spine than the other.

• Range of motion measures the degree to which a patient can perform movements of flexion, extension, lateral bending, and spinal rotation. The doctor also notes asymmetry.

 

Neurological Examination

 

Patients are assessed for underlying neurological problems that may be causing scoliosis. The following symptoms are assessed:

 

• pain

• numbness

• paresthesias (eg, tingling)

• extremity sensation and motor function

• muscle spasm

• weakness

• bowel/bladder changes.

 

Radiographs (X-rays) Show the Scoliotic Curve

 

X-rays indicate if the scoliotic curves are structural (major) or non-structural (minor).   If possible find an Xray centre that has an EOS solution which is a low dose imaging full spinal solution.

 

To see the entire length of the spine, the doctor will have the patient stand.  Two views are typically taken in x-rays for scoliosis: 

 

PA (posterior-anterior, or back to front) and lateral (side) x-rays.

 

Side bending AP (anterior-posteriod, or front to back) x-rays are sometimes done to assess spinal flexiblity.