Scoliosis Diagnosis

By: Peter F. Ullrich, Jr., MD
October 7, 2007

• Also see:
• Scoliosis Causes
• Scoliosis Symptoms
• Scoliosis Treatment
• Scoliosis Surgery

Early detection is essential for scoliosis treatment to be most effective. In general, people with a family history of spinal deformity are at greater risk for developing scoliosis.

Scoliosis testing

Frequently, a scoliosis curve in the spine is first diagnosed in school exams or in a regular check up with a pediatrician. Most students are given the Adam’s forward bend test routinely in school when they are in fifth and/or sixth grade to determine whether or not they may have scoliosis. The test involves the student bending forward with arms stretched downward toward the floor and knees straight, while being observed by a healthcare professional. This angle most clearly shows any asymmetry in the spine and/or trunk of the adolescent’s body.

Because a scoliosis curvature is usually in the thoracic or thoracolumbar spine (upper back or mid back), if a rib hump or asymmetry of the lumbar spine is found, or if the shoulders are different heights, it is possible that the individual has scoliosis. If this is the case, follow-up with a physician for a clinical evaluation and an x-ray is the next step.

• Physician’s exam. The clinical evaluation with the physician will usually include a physical exam, during which the physician will also test to make sure that there are no neurological deficits. Neurological deficits due to scoliosis are uncommon but necessary to check for because there are rare causes of scoliosis that may have spinal cord involvement.

• X-ray. The x-ray is ordered to both confirm the scoliosis diagnosis and check on the magnitude of the spinal curvature. The x-ray will also give some indication as to the skeletal maturity of the patient which may influence treatment decisions.

In rare instances a physician may also request an MRI scan of the thoracic and/or cervical spine. If there are any neurological deficits that would indicate impingement of the spinal cord (e.g. brisk reflex), if there is a left-sided thoracic curvature (they are almost always right sided), or if the child is very young (8 to 11 years old), an MRI scan is advisable to examine the possibility of an intracanal spinal lesion, which can cause scoliosis.

Depending on the results of the physician’s clinical evaluation and the diagnostic tests, a scoliosis treatment plan will be recommended that may include observation, bracing, or possibly surgery to reduce or correct the spinal curve.

Peter F. Ullrich, Jr., MD
October 7, 2007