Children are routinely screened for adolescent idiopathic scoliosis at their yearly physical exam, most commonly with the Adam’s Forward Bend Test, a technique that is easily performed at a doctor’s office or school setting. The patient stands with both feet together and the toes even. With either the shirt lifted or removed, the patient bends forward at the waist as far as they can with palms held together, as if they are going to touch their toes. The examiner then inspects the patient from behind, looking for abnormalities or differences between the left and right side of the body. A patient with scoliosis may have a shoulder, scapula, or ribs that sit higher on one side and there may be a visible curve of the spine. If the Adam Bend Test reveals abnormalities, further evaluation would be prompted.
The best way to diagnosis scoliosis is with x-ray imaging because this can uncover underlying causes including partially formed vertebral bodies, fused vertebral bodies, or lack of skeletal maturity and it can determine the degree or progression of spinal curvature. Special scoliosis x-rays show the entire spine with the shoulders and pelvis which emphasizes unevenness of the hips or shoulders in comparison to the curvature of the spine. X-rays are completed while the patient is weight bearing (standing), as this position allows gravity to act on the spine and gives the most accurate representation. The severity of scoliosis is determined by a specific angle, called the Cobb angle.
X-rays are mostly used for the diagnosis of scoliosis; 3D imaging with CT (Computed Tomography Scan) or MRI (Magnetic Resonance Imaging) scans is often needed to assess the cause. CT scans are mainly used to assess the bony anatomy of the spine; it would be used to look for any partially formed vertebral bodies, or fused vertebrae. MRI scans are primarily used to look at the soft tissue of the body, such as intervertebral discs and nerves. These scans reveal degenerative changes that could lead to scoliosis, such as facet joint disease or degenerative disc disease, and can also reveal conditions caused by scoliosis, such as disc herniation or spinal stenosis.
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