Childhood Testing for Scoliosis
How Scoliosis Is Diagnosed
As soon as you think that you or your child has scoliosis, you should see the doctor. Early diagnosis and treatment is the best way to prevent curve progression.
For some parents and children, it's a school nurse who first notices the scoliosis. In many schools in America, children are screened around fifth or sixth grade. The nurse generally uses the Adam's Forward Bending Test. With that, the child bends forward at the waist and reach his or her arms straight outward, positioned as though diving into a swimming pool. This usually reveals abnormalities, such as a rib hump or an incorrect shape of the back.
The Adam's Forward Bending Test helps identify an unusual curve, but it can't tell you how severe the curve is. For that, you'll need to go to a doctor. Using different tests, the doctor will be able to see and measure the curve.
- Plumb line test: This is a quick visual check to see if the spine is straight. In scoliosis, the plumb line will fall to the left or right of the spine instead of through the middle of the buttocks.
- Scoliometer: If the doctor sees a rib hump, he or she can use a scoliometer to measure the size of the hump. It's a painless and non-invasive test.
- X-ray: An x-ray can help the doctor confirm scoliosis by showing exactly where the scoliosis affects the spine and the extent of the curve.
If needed, the doctor will order x-rays of the entire spine. The x-rays will capture pictures of the front, back, and sides of the spine. Sometimes, bending x-rays are ordered to help your doctor see the normal and abnormal curves.
Using an x-ray (or sometimes an MRI or a bone scan) of the spine, the doctor can calculate the severity of the curve. This is done with the Cobb method. That puts the curve in terms of degrees. Curves greater than 25º to 30º are considered significant; if it's greater than 45º to 50º, it's called severe.
The doctor will also do physical and neurological exams.
In the physical exam, the doctor will observe posture, range of motion, and physical condition, noting any movements that cause pain. Your doctor will feel the spine, note its curvature and alignment, and feel for muscle spasm.
During the neurological exam, the doctor will test reflexes, muscle strength, other nerve changes, and pain spread. This is all to get a better picture of your general health (or your child's).
For children, the doctor will also want to determine the child's skeletal maturity (ie, how much growing he or she has left to do). The doctor may use an x-ray to determine the skeletal age. That's an important thing to know because how much growing a child has left to do determines scoliosis treatment options. To figure out the skeletal age, the doctor can order a wrist x-ray and compare that to the Greulich and Pyle standard classification. By comparing the results of the wrist x-ray to a national standard, the doctor can decide how much growth is left and if the scoliosis is likely to progress.
Also to help determine skeletal maturity, the doctor will want to know the age of onset of puberty (for boys) and the age of onset of menstruation (for girls).
Throughout all these exams and tests, the doctor is looking for two main things: the severity of the scoliosis and the cause. Both help determine the treatment plan for scoliosis in children and adults.