Symptoms and diagnosis of idiopathic scoliosis

People with a family history of spinal deformity are at greater risk for developing scoliosis. Early detection is essential.

There are several common physical symptoms that may indicate scoliosis. Any type of back pain is not usually considered a scoliosis symptom. Most typically, symptoms of scoliosis may include one or several of the following:

• One shoulder is higher than the other

• One shoulder blade sticks out more than the other

• One side of the rib cage appears higher than the other

• One hip appears higher or more prominent than the other

• The waist appears uneven

Frequently, a scoliosis curve in the spine is first diagnosed in school exams or in a regular check up with a pediatrician. Most students are given the Adam’s forward bend test routinely in school to determine whether or not they may have scoliosis. The test involves the student bending forward with arms stretched downward toward the floor and knees straight, while being observed by a healthcare professional. This angle most clearly shows any asymmetry in the spine and/or trunk of the adolescent’s body.

Because a scoliosis curvature is usually in the thoracic or thoracolumbar spine (upper back or mid back), if a rib hump or asymetry of the lumbar spine is found, or if the shoulders are different heights, it is possible that the patient has scoliosis. If this is the case, follow-up with a physician for a clinical evaluation and an x-ray is the next step.

• Physician’s exam. The clinical evaluation with the physician will usually include a physical exam, during which the physician will also test to make sure that there are no neurological deficits, which are uncommon but necessary to check for.

• X-ray. The x-ray is ordered to both confirm the diagnosis and check on the magnitude of the curvature. The x-ray will also give some indication as to the skeletal maturity of the patient (See Figure 2).

In rare instances a physician may also request an MRI scan of the thoracic and/or cervical spine. If there are any neurological deficits that would indicate impingement of the spinal cord (e.g. hyperactive reflexes), if there is a left-sided thoracic curvature (they are almost always right sided), or if the child is very young (8 to 11 years old), an MRI scan is advisable to examine the possibility of an intracanal spinal lesion, which can cause scoliosis.

Depending on the results of the physician’s clinical evaluation and the diagnostic tests, a treatment plan will be recommended that may include observation, bracing, or possibly surgery.