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Initial imaging evaluation of a patient suspected of having scoliosis is by
a standing posterior-anterior thoracolumbar spine radiograph done on a single
long film. Modern radiographic techniques minimize radiation exposure (Fig.5).
A standing side view radiograph of the thoracolumbar spine is suggested if
significant deformity is present in the front-to-back (sagittal) plane. Radiographs
are assessed for spinal column contour and to rule out congenital, developmental,
degenerative or neoplastic abnormalities. The amount of each deformity is calculated
using a standard, reproducible measurement technique. An estimate of skeletal
maturity is made by assessment of the growth areas at the upper pelvis and hips
(Fig.6).
Figure 5. Screening PA erect
Figure 6. Risser's sign
and triradiate cartilage status
Specialized imaging studies such as (CT scans or magnetic resonance
imaging (MRI)) may occasionally be needed. Magnetic resonance imaging is done
to evaluate the spinal cord and spinal nerves (Fig.7).
As with all studies, MRI is done for a specific indication and correlated with
clinical examination. Myelography, a radiographic study which uses an injected
dye to provide contrast to study the spinal canal and its contents, has been
largely replaced by magnetic resonance imaging techniques. CT scans are used
to provide improved definition of abnormalities of vertebral size, shape or
number (Fig.8).
Figure 7. Lateral T-L spine
Figure 8. Congenital lumbar
scoliosis - 3D CT reconstruction
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