Scoliosis is one of the most common childhood spinal conditions. Overall, the disease affects roughly 1 to 2 percent of the American population, or 6 to 9 million people. Although the condition can affect anyone, it most often presents between the ages of 10 and 15.
As far as spinal conditions go, most cases of scoliosis are relatively mild. Very often it causes nothing more than a visual deformity of the back, such as uneven shoulders or uneven hips. However, scoliosis can and does cause other symptoms that can interfere with your child’s quality of life, especially in moderate or severe cases.
These symptoms can include:
- Back pain
- Leg pain
- Trouble walking
- Trouble breathing
That’s why it is important to get a firm scoliosis diagnosis as soon as you or your child notices any visual symptoms so that your pediatric orthopedic specialist can then monitor your child’s condition. That way, if the condition progresses, you, your child and your treatment team will be prepared to act.
How to Diagnose Scoliosis
When a parent suspects scoliosis in their child comes to me, I usually start with a physical exam and medical history. The medical history can give me a sense of when the problem may have started or became noticeable.
How long has the parent or child suspected an abnormal curvature? Did noticing it coincide with a growth spurt? The answers to these questions will give a pediatric spine specialist key insights into the development of scoliosis in the patient.
I’ll also take into account the patient’s age—as mentioned, scoliosis usually occurs between the ages of 10 and 15—and gender. Girls are much more likely to develop scoliosis than boys. A family history of scoliosis is good to know about because the condition tends to run in families, which suggests a genetic component.
The physical exam is probably the most important aspect of a scoliosis diagnosis. My first step will be a visual inspection of the child’s back. I’ll be looking at the hips and shoulders to check for unevenness. Because scoliosis is an abnormal curvature of the spine to either the left or the right, the condition often throws the hips, shoulders or both out of alignment with each other, a key clue for diagnosis.
I also use a number of scoliosis tests to help confirm a diagnosis. You may remember the first test as one administered by a middle school nurse. It is called the Adam’s Forward Bend test.
The patient stands up straight and then bends forward at the waist to a 90-degree angle, so his or her chest is parallel with the floor. This allows me to better see any inconsistencies in the symmetry of the shoulders and hips.
Imaging Studies for Scoliosis
If the Adam’s Forward Bend test is insufficient to diagnose scoliosis, I’ll next order an imaging study. X-rays are the most common because they depict the position of the individual vertebrae very well. Other tests can include computed tomography (CT) or magnetic resonance imaging (MRI) scans.
Once the X-ray or other imaging study has been completed, I’ll determine the presence and severity of scoliosis using the Cobb Method, a technique for measuring the side-to-side curvature of the spine. An angle of more than 10 degrees indicates scoliosis, and an angle of more than 25 degrees usually means the patient needs a back brace. At 50 degrees, surgery may be the treatment of choice.
Another tool I use is called a scoliometer. Often used in conjunction with the Adam’s test, a scoliometer is a handheld tool that looks like a small level. It is used to measure the rotation of the individual vertebrae. A rotation of 5 degrees or greater indicates scoliosis.
Once scoliosis is diagnosed, it can then be treated. For mild cases, treatment might mean simply monitoring the condition to ensure the curvature does not worsen. A back brace can help prevent the curve from progressing in mild to moderate cases.
For severe cases, surgery may be necessary. Surgery for scoliosis is usually done from the back. Once the incision is made, surgeons will affix rods and screws to the spine to correct the curve and keep the curve from increasing as the patient finishes growing.
The majority of scoliosis cases can be treated without surgery. If you suspect your child may have scoliosis, request an appointment with me to get a firm diagnosis and learn about treatment options.