Diagnosing Scoliosis: Tips for the Practitioner

By John J. Vaughan, MD


Figure 1

Scoliosis is defined as an abnormal sideways or lateral curvature of the spine (Figure 1). It affects up to 2% or 3% of the population. When progressive scoliosis is discovered in its early stages in a growing adolescent, appropriate treatment can be instituted that would lessen the need for surgical intervention. This article will provide a brief review of the screening procedures for scoliosis that health providers may use.

In our practice, we have found that most cases of scoliosis are discovered by a patient's primary care physician or by a nurse in school screening programs. Parents or family members also may frequently notice such things as one shoulder or hip being higher than the other, a crooked hemline on dresses, or an abnormal "crease" at the waist. These findings often prompt a visit to the doctor.

Progressive scoliosis is most commonly seen in the late childhood or teenage years, at the time when the growth spurt occurs. Girls are more commonly affected than boys.

Simple observation of the torso from behind during a physical examination can show many of the telltale signs of scoliosis (Figure 2). One shoulder or shoulder blade may be higher than the other. One hip or iliac crest may be more prominent. In thin patients, the spinous process can frequently be seen in a curved pattern. When the patient is asked to bend forward, a "rib hump" is seen on one side of the chest (Figure 3). This is a prominence of the ribs caused by the rotation of the vertebrae involved with the scoliosis. Once scoliosis is suspected in a growing adolescent, an evaluation by an orthopaedic surgeon is appropriate. An x-ray of the spine, taken with the patient in the standing position, will determine whether scoliosis is truly present. If it is, the magnitude and type of scoliosis can be determined.



Figure 2

Figure 3

Ninety percent of cases of scoliosis do not progress significantly, and no active treatment is required. The small number of cases that do progress, though, can sometimes be caught early and controlled in a brace. Scientific studies have shown that, in cases of progressive scoliosis, bracing can lessen the chances of further progression of the curve and, hence, lessen the chance that surgery will be needed.

Further information and a guidebook for screening for scoliosis can be obtained by sending an e-mail message to kyspine@aol.com.

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Last Updated: 10/4/03