Diagnosing Scoliosis
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The doctor takes the following steps to evaluate a patient
for scoliosis:
- Medical history--The doctor talks to the patient and the
patient's parent or parents and reviews the patient's records to look
for medical problems that might be causing the spine to curve, for
example, birth defects, trauma, or other disorders that can be
associated with scoliosis.
- Physical examination--The doctor looks at the patient's
back, chest, pelvis, legs, feet, and skin. The doctor checks if the
patient's shoulders are level, whether the head is centered, and
whether opposite sides of the body look level. The doctor also
examines the back muscles while the patient is bending forward to see
if one side of the rib cage is higher than the other. If there is a
significant asymmetry (difference between opposite sides of the body),
the doctor will refer the patient to an orthopaedic spine specialist
(a doctor who has experience treating people with scoliosis). Certain
changes in the skin, such as so-called caf au lait
(coffee-with-milk-colored) spots, can suggest that the scoliosis is
caused by a birth defect.
- X-ray evaluation--Patients with significant spinal curves,
unusual back pain, or signs of involvement of the central nervous
system (brain and spinal cord) such as bowel and bladder control
problems need to have an x ray. The x ray should be done with the
patient standing with his or her back to the x-ray machine. The view
is of the entire spine on one long (36-inch) film. Occasionally,
doctors ask for more tests to see if there are other problems.
- Curve measurement--The doctor measures the curve on the
x-ray image. He or she finds the vertebrae at the beginning and end of
the curve and measures the angle of the curve (see "Curve
Patterns" diagram). Curves that are greater than 20 degrees
require treatment.
Doctors group curves of the spine by their location,
shape, pattern, and cause. They use this information to decide how best
to treat the scoliosis.
- Location--To identify a curve's location, doctors find the
apex of the curve (the vertebra within the curve that is the most
off-center); the location of the apex is the "location" of the curve.
A thoracic curve has its apex in the thoracic area (the part of the
spine to which the ribs attach). A lumbar curve has its apex in the
lower back. A thoracolumbar curve has its apex where the thoracic and
lumbar vertebrae join (see "Normal
Spine" diagram).
- Shape--The curve usually is S- or C-shaped.
- Pattern--Curves frequently follow patterns that have been
studied in previous patients (see "Curve Patterns" diagram). The
larger the curve is, the more likely it will progress (depending on
the amount of growth remaining).
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