Scoliosis Diagnosis

Patients who initially present with scoliosis are examined to determine if there is an underlying cause of the deformity.

During a physical examination, evaluate the following:
Skin spots are indicative of neurofibromatosis;
The feet of the deformity cavovarus;
Abdominal reflexes;
Muscle tone for spasticity.
During the examination, the patient is asked to remove their shirt and lean forward.  (This is known as the forward-bending Adams test and is often performed by students of the school).  If you see a prominence, then scoliosis is a possibility and the patient should be sent to an X-ray for diagnosis.

Alternatively, a scoliometer can be used to diagnose the disease.   The patient’s gait is assessed, and a test for signs of other abnormalities (e.g. spina bifida as evidenced by a dimple, hairy, lipoma or hemangioma).

A complete neurological examination can be done as well.  It is usual when scoliosis is suspected, that they have a full weight-bearing spine AP/coronal (frontal posterior view) and lateral/sagittal (side view) X-ray taken to evaluate the curves scoliosis, kyphosis and lordosis, as these may also be affected in people with scoliosis.

Full-length standing spine X rays are the standard method for assessing the severity and progression of scoliosis, and whether it is congenital or idiopathic in nature.  In growing individuals, serial radiographs are obtained at intervals of 3-12 months and follow the progression of the curve.  In some instances, MRI investigation is warranted to examine the spinal cord.

The standard method to quantitatively assess the curve is the Cobb angle measurement.  The Cobb angle is the angle between two lines, perpendicular to the superior endplate of the upper vertebra and the inferior endplate involving the lower vertebrae that is affected.

For patients who have two curves, Cobb angles are followed for the two curves.  In some patients, lateral bending x-rays are obtained to assess the flexibility of the curves or the curves of primary and compensation.  Genetic testing for AIS, which is available in 2009 and is still under investigation, attempts to measure the risk of progression of the curve.