As soon as you think that you or your
child has scoliosis, you should see the doctor. Early diagnosis and
treatment is the best way to prevent curve progression.
For some parents and children, it's a
school nurse who first notices the scoliosis. In many schools in America,
children are screened around fifth or sixth grade. The nurse generally
uses the Adam's Forward Bending Test. With that, the child bends forward
at the waist and reach his or her arms straight outward, positioned as
though diving into a swimming pool. This usually reveals abnormalities,
such as a rib hump or an incorrect shape of the back.
The Adam's Forward Bending Test helps
identify an unusual curve, but it can't tell you how severe the curve is.
For that, you'll need to go to a doctor. Using different tests, the doctor
will be able to see and measure the curve.
- Plumb line test: This is a
quick visual check to see if the spine is straight. In scoliosis, the
plumb line will fall to the left or right of the spine instead of
through the middle of the buttocks.
- Scoliometer: If the doctor
sees a rib hump, he or she can use a scoliometer to measure the size of
the hump. It's a painless and non-invasive test.
- X-ray: An x-ray can help the
doctor confirm scoliosis by showing exactly where the scoliosis affects
the spine and the extent of the curve.
If needed, the doctor
will order x-rays of the entire spine. The x-rays will capture pictures
of the front, back, and sides of the spine. Sometimes, bending x-rays
are ordered to help your doctor see the normal and abnormal curves.
Using an x-ray (or sometimes an MRI
or a bone scan) of the spine, the doctor can calculate the severity of the
curve. This is done with the Cobb method. That puts the curve in terms of
degrees. Curves greater than 25º to 30º are considered significant; if
it's greater than 45º to 50º, it's called severe.
The doctor will also do physical and
neurological exams. In the physical exam, the doctor will observe posture,
range of motion, and physical condition, noting any movements that cause
pain. Your doctor will feel the spine, note its curvature and alignment,
and feel for muscle spasm. During the neurological exam, the doctor will
test reflexes, muscle strength, other nerve changes, and pain spread. This
is all to get a better picture of your general health (or your
child's).
For children, the doctor will also
want to determine the child's skeletal maturity (i.e., how much growing he
or she has left to do). The doctor may use an x-ray to determine the
skeletal age. That's an important thing to know because how much growing a
child has left to do determines scoliosis treatment options. To figure out
the skeletal age, the doctor can order a wrist x-ray and compare that to
the Greulich and Pyle standard classification. By comparing the results of
the wrist x-ray to a national standard, the doctor can decide how much
growth is left and if the scoliosis is likely to
progress.
Also to help determine skeletal
maturity, the doctor will want to know the age of onset of puberty (for
boys) and the age of onset of menstruation (for
girls).
Throughout all these exams and tests,
the doctor is looking for two main things: the severity of the scoliosis
and the cause. Both help determine the treatment plan.
