The Straight Talk on Scoliosis By Jill C. Wilkens M.D.
Scoliosis (derived from the Ancient Greek word meaning crooked or bent) is the side to side curvature of the spine. The spine may have an “S” or “C” shape. It is classified as congenital (present at birth), idiopathic (unknown-the most common cause, about 80% of all cases), or neuromuscular (from trauma or nerve or muscular condition).
It affects about 3% of the population and mild scoliosis occurs equally in males and females. In females, however, it is eight times more likely to progress to the severity that requires treatment. Curves greater than 30 degrees occur in approximately 0.2 percent of cases, and curves greater than 40 degrees have 0.1 percent prevalence.
Scoliosis may be present without signs or symptoms or there may be indications such as uneven shoulders or rib cage, leg length discrepancy, uneven hips or waist, head not centered above pelvis, or entire body leaning to one side. Some patients may even complain of chronic back pain or breathing difficulties due to the changes in the shape of the chest cavity.
It is often detected at puberty during a check up at the doctor’s office or during school screenings using the Adam’s Forward Bend Test. During this test, your child is asked to bend forward at the waist with feet together and dangle the arms while the examiner makes a simple assessment of the spine. This test is a good initial screening test although it is not sensitive to curves in the lower back and may miss approximately 15% of cases.
If there is any concern regarding abnormal spinal curvatures, x-rays should be ordered to diagnose and accurately measure the scoliosis. X-rays emit very low dose radiation and are performed with the patient optimally shielded. They not only accurately assess the severity of scoliosis, but also determine other potential spinal abnormalities. A positive diagnosis of scoliosis is made if there is a curvature of greater than 10 degrees. Curves greater than 25 degrees are considered significant and for curves greater than 45 degrees, aggressive treatment like surgery is usually necessary.
There are many factors that are considered to help determine treatment after the diagnosis has been made. These include the severity of the curvature, the possibility of curve progression (is the patient still growing?), and location of the curve. Some believe that thoracic (mid) spine curves are more likely to progress than curves in other locations of the spine. If the curve is mild, regular check-ups and periodic x-rays may be enough to make sure it doesn’t progress. If it is more severe, usually greater than 25 degrees, a brace may be implemented. After the adolescent years when the spine stops growing, braces are typically ineffective.
After the diagnosis of scoliosis has been made, in certain cases, advanced imaging techniques such as MRI (which does not emit radiation) can identify possible causes such as spinal cord or neurologic abnormalities. MRI and CT may be useful to the surgeon for preoperative planning and postoperative evaluation if surgery is determined to be the treatment of choice in more severe cases.
At Progressive Radiology, we specialize in pediatric imaging and perform studies such as scoliosis digital x-rays, MRI and low dose CT. Your child’s safety is paramount to us and therefore, we subscribe to the "Image Gently" campaign. We use specialized protocols and shielding techniques to reduce radiation for all of our patients.
If you are concerned that your child may have scoliosis, please consult your medical provider.
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