Early detection important in scoliosis diagnosis

Scoliosis is the most common deformity of the spine and is diagnosed when lateral and rotational abnormalities are present. Lateral curvatures are indicated by a side-to-side bow, or S-shaped spinal column, while rotational deformities occur when the vertebrae are twisted to one side or the other. Both aspects of scoliosis must be present to make a diagnosis of the condition.

“A normal spine has three front-to-back curves between the neck and the pelvis,” said Anderson. “A child with scoliosis will present with a spine that also curves abnormally to the side and is twisted either to the right or the left.”

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Initial Scoliosis Diagnosis

The initial diagnosis of scoliosis is usually made by a physical exam using the forward bending or Adams test. Although some doctors then use a scoliometer to measure the curve if the child is thought to have scoliosis, for a more definitive diagnosis, a scoliosis x-ray is usually done. The radiologist can then use the Cobb method to see how much scoliosis your child has or how many degrees her curve is.

In general, scoliosis is defined as a lateral curve of the spine greater than 10 degrees, as measured on a standing x-ray.

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Scoliosis Tests and Diagnosis

Your child's doctor may check for scoliosis at routine well-child visits. Many schools also have screening programs for scoliosis. If your child has a positive screen for scoliosis at school, see your doctor to confirm the condition.

Your doctor will ask about your child's personal and family medical history and may take these diagnostic steps:

Physical examination. Your doctor examines the spine as well as the shoulders, hips, legs and rib cage for signs of scoliosis.
X-rays. Your doctor may order an initial X-ray to confirm the diagnosis and determine the size of the spinal curvature. After that, periodic X-rays are done to monitor the curve and help make treatment decisions.
Doctors describe a child's scoliosis based on the shape and size of the curve, the location of the curve and other factors:

Shape. Curves develop side to side as a C- or S-shaped curve. The rotation of the spine causes the ribs and muscles near the spine to move out of normal alignment.

Location. The curve may occur in the upper back area where the ribs are located (thoracic), the lower back area (lumbar) or in both areas (thoracolumbar).

Direction. Scoliosis can bend the spine to the left or to the right.

Angle. Doctors measure the angle of the curve on X-rays. A normal spine without scoliosis, viewed from the back, measures zero degrees — a straight line. A very large curve that bends the spine to a horizontal position, or parallel to the floor, is described as at 90 degrees. Scoliosis is defined as a spinal curvature of greater than 10 degrees. Most doctors can detect even mild curves during a physical exam but use X-rays to measure the size of the scoliosis. Your child's doctor can compare these measurements over time to see if the curve is getting worse.

Cause. About 85 percent of scoliosis cases are idiopathic, meaning the cause is unknown.

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