Patients who initially present with scoliosis are examined to determine whether there is an underlying cause of the deformity. During a physical examination, the following is assessed:
- Skin for café au lait spots indicative of neurofibromatosis
- The feet for cavovarus deformity
- Abdominal reflexes
- Muscle tone for spasticity
During the exam, the patient is asked to remove his shirt and bend forward (this is known as the Adam's Bend Test and is often performed on school students). If a hump is noted, then scoliosis is a possibility and the patient should be sent for an x-ray to confirm the diagnosis. Alternatively, a scoliometer may be used to diagnose the condition.
The patient's gait is assessed, and there is an exam for signs of other abnormalities (''e.g.'', Spina bifida as evidenced by a dimple, hairy patch, lipoma, or hemangioma).
A thorough neurological examination is also performed.
It is usual when scoliosis is suspected to arrange for weight-bearing full-spine AP/coronal (front-back view) and lateral/sagittal (side view) xrays to be taken, to assess both the scoliosis curves and also the kyphosis and lordosis, as these can also be affected in individuals with scoliosis. Full-length standing spine X rays are the standard method for evaluating the severity and progression of the scoliosis, and whether it is congenital or idiopathic in nature. In growing individuals, serial radiographs are obtained at 3-12 month intervals to follow curve progression. In some instances, MRI investigation is warranted.
The standard method for assessing the curvature quantitatively is measurement of the Cobb angle, which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost vertebrae involved and the lower endplate of the lowest vertebrae involved. For patients who have two curves, Cobb angles are followed for both curves. In some patients, lateral bending xrays are obtained to assess the flexibility of the curves or the primary and compensatory curves.
Genetic testing for AIS, which has become available in 2009, greatly improves the ability of physicians to accurately predict the likelihood of curve progression.
- Mass-screening for scoliosis using posture photos
It has been suggested that entire populations be examined, for early detection. For example, in the 1940s, American psychologist William Sheldon proposed mandatory physical examinations that included nude photographs of each person being examined. One purpose of these photographs was the detection of rickets, scoliosis, and lordosis. His approach was implemented at a number of ivy league schools in which all freshmen were examined (Ivy League nude posture photos). A similar program was implemented in Boston's prison system.
Further Reading
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"Scoliosis"
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