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 idiopathic scoliosis.
Early Detection for Scoliosis
Frequently, a scoliosis curve in the spine is first diagnosed in school exams or during a regular checkup 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 scoliosis symptoms which present as asymmetry in the spine and/or trunk of the adolescent's body.
Further Scoliosis Testing
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.
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In rare instances a physician also may request an MRI scan of the thoracic and/or cervical spine to explore the possibility of an intracanal spinal lesion. Signs of a spinal lesion include:
- Neurological deficits, such as leg numbness or weakness, that indicate impingement of the spinal cord (e.g. brisk reflex)
- A left-sided thoracic curvature, called levoscoliosis (the curves are almost always right sided)
- If the child is younger (e.g. 8-11 years old) than a typical patient with scoliosis
Formulating a Treatment Plan
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.