Adult Scoliosis: Diagnostic Process
Part 2 of 3
Adult scoliosis requires a careful review of the patient's personal and family medical histories. Any history of smoking is noted. Spinal joint and/or peripheral vascular disease is assessed for involvement as these are known to cause back pain similar to scoliosis. In severe scoliosis, the patient's cardiopulmonary (heart and lung) function may be evaluated.
Physical Examination
A thorough physical examination reveals a lot about the health and general fitness
of the patient. The exam provides a baseline from which the physician can measure
the patient's progress during treatment. The physician will observe the patient
standing (front and back) and look for any asymmetric abnormalities in the shoulders,
rib cage, waist, and pelvis. Patients with scoliosis may present humpback, one
hip higher than the other, or appear to be listing to one side. In severe scoliosis,
cardiopulmonary function is tested. The physical examination also includes:
1. Adam's Forward Bending Test requires the patient to bend forward at the waist. Viewed posteriorly (from behind), scoliosis is suspected if a thoracic (mid-back) or lumbar (low-back) prominence is apparent.
2. A rib hump can be measured in degrees using a Scoliometer. While the patient is bent at the waist, the scoliometer is placed over the rib hump.
3. Leg length is measured and compared to determine discrepancy.
4. A plumb line held posteriorly at the 7th cervical vertebral (C7) is allowed to hang below the buttocks. In a normal spine, the line passes through the gluteal crease (middle of buttocks). In scoliosis, the scoliotic portions of the spine may fall to the right or left of the line.
5. Palpation determines spinal abnormalities by feel. The ribs (thoracic) or lumbar muscles may feel more prominent on one side of the spine than the other.
6. Range of Motion measures the degree to which a patient can perform movements of flexion, extension, lateral bending, and spinal rotation. Asymmetry is also noted.
Neurological Examination
The neurological evaluation includes an assessment of the following symptoms:
pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor
function, muscle spasm, weakness, and bowel/bladder changes. Particular attention
is given to identifying the pain pattern.
Radiographs
X-rays indicate if the scoliotic curves are structural (major) or non-structural
(minor). The patient stands to reveal the entire length of the spine when PA
(posterior/anterior, or back and front) and Lateral (side) x-rays are taken.
Side bending AP x-rays are sometimes used to evaluate spinal flexibility.
Curve Classification
Curves are classified according to pattern (shape) and magnitude (severity).
1. King Classification divides scoliotic curves into one of five patterns. For example, King Type III curves are primarily single thoracic curves.
2. Cobb Angle Measurement uses a standard full-length AP x-ray. Geometric calculations determine the angle of the curve in degrees.
3. Nash-Moe technique measures pedicle rotation by dividing the vertebral body into segments. The segment into which the pedicle is located quantifies rotation.
Harry N. Herkowitz, MD
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