Scoliosis: The Diagnostic Process

This post seeks to empower through understanding. Scoliosis is a 3-dimensional curvature of the spine and can be classified as functional or structural. This post focuses on structural scoliosis. A common classification system divides structural scoliosis into the following categories:

  1. Idiopathic
  2. Degenerative
  3. Neuromuscular
  4. Congenital
  5. Other

The most common type of scoliosis is idiopathic. Idiopathic is often divided into three categories: infantile (< 3 years old), juvenile (3-10 years old), and adolescent (10 years old to skeletal maturity). The most common of these is adolescent, referred to as Adolescent Idiopathic Scoliosis (AIS).

Healthcare practitioners may evaluate Scoliosis in any number of ways. But, generally, all include a detailed history and physical exam, with the possible addition of ancillary tests such as imaging (x-rays). The goal of this post is to enhance the diagnostic and therapeutic process by preparing you for a scoliosis-specific visit. This post is not all encompassing, but it gives you an idea of the details that are important. The history questions and physical exam procedures are designed to rule out neuromuscular, congenital, and other causes of scoliosis; in addition, they determine the risk for curve progression, guide appropriate management, and allow care to be individualized.

History

During the history, questions relating to the following may be asked:

  1. Birth history & perinatal period
  2. Developmental milestones
  3. Menarcheal status (if female)
  4. Review of other physiological systems, including integrity of the following:
    1. Neurological (weakness, changes in bowel or bladder habits, etc.)
    2. Cardiovascular
    3. Respiratory
    4. Renal
    5. Skin
  5. Age when deformity was first identified
  6. Progression of curve since identification
  7. Family history of scoliosis
  8. Function during activities of daily living
  9. Nutritional inadequacies

Physical Exam

During the physical exam, the practitioner may assess:

  1. Height & weight
  2. Spinal alignment & the degree of spinal curve
    1. Asymmetries in: rib prominences, shoulders, scapulae, pelvis, trunk/flank, and leg length
    2. A scoliometer may be used to assess severity of the curve
  3. The neurological system
    1. Through tests of: balance, muscle strength, reflexes, and sensation
  4. The skin
    1. For any abnormalities, asymmetries, or breakdown
  5. The biomechanical system
    1. This includes the interaction and function of joints, muscles, and nerves within the context of the kinetic chain.
    2. As neuromuscular and congenital causes of scoliosis are ruled out, a comprehensive biomechanical evaluation allows care for idiopathic scoliosis to be individualized!

Ancillary

FullSizeRender (4).jpgAfter a detailed history and physical exam, if necessary, the healthcare practitioner may request X-rays and/or an MRI. Radiographs are not necessary for every patient, but may be required if the curve is obviously significant or if there has been significant curve progression in a short period of time. Radiographs are also used to measure the degree of spinal curve, important in the diagnose scoliosis. Scoliosis is defined as a curve (Cobb angle) greater than 10 degrees (see drawing). An MRI may be requested if there is suspicion of an intra-spinal pathology.

Management

The next post will discuss conservative care options for management of Adolescent Idiopathic Scoliosis (AIS). Stay tuned!

Take-away

As always, talk to a healthcare practitioner you trust for more information! Not all the steps in this post are required for every visit. The process is different for each individual and each practitioner. 

References

Allam, A. & Schwabe, A. (2013). Neuromuscular scoliosis. PM&R., 5(11), 957-963

Burton, M. (2013). Diagnosis and treatment of adolescent idiopathic scoliosis. Pediatr Ann., 42(11), e233-e237