What are the steps for diagnosing and treating scoliosis?

From the Guidelines

Diagnosing and treating scoliosis involves a systematic approach beginning with a thorough physical examination, including neurological screening tests and assessment of mobility and/or muscle strength, as recommended by high-quality clinical practice guidelines 1. The diagnosis of scoliosis is typically made through a combination of physical examination and imaging studies. Key points to consider in the diagnosis and treatment of scoliosis include:

• A thorough physical examination to check for spine curvature, shoulder unevenness, and waist asymmetry
• Imaging studies, primarily X-rays to measure the Cobb angle (degree of curvature), with MRI sometimes used to identify underlying causes, particularly in cases of congenital scoliosis or when risk factors for neural axis abnormalities are present 1
• Treatment depends on curve severity, patient age, and growth potential
• For mild curves (less than 25 degrees), observation with regular X-rays every 4-6 months during growth periods is typically recommended
• Moderate curves (25-40 degrees) often require bracing, with the Boston or Milwaukee brace worn 16-23 hours daily until skeletal maturity to prevent progression
• Severe curves (over 40-50 degrees) or those rapidly progressing typically require surgical intervention, most commonly posterior spinal fusion with instrumentation to straighten and stabilize the spine using rods and screws The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for the diagnosis and treatment of scoliosis, including the use of radiography and MRI in the evaluation and management of scoliosis 1. Some key considerations in the diagnosis and treatment of scoliosis include:
• The importance of early diagnosis and treatment, particularly during adolescent growth spurts, when the spine is most flexible and responsive to treatment
• The need for regular follow-up and monitoring to detect curve progression and adjust treatment as needed
• The role of physical therapy in complementing bracing and surgical treatment, focusing on core strengthening and posture improvement to optimize outcomes.

From the Research

Diagnosis of Scoliosis

• Scoliosis is a spinal deformity consisting of lateral curvature and rotation of the vertebrae, with causes classified as congenital, neuromuscular, syndrome-related, idiopathic, and spinal curvature due to secondary reasons 2.
• The diagnosis of scoliosis involves a patient's history, physical examination, and radiographs, with the Cobb angle being a key measurement to assess the degree of curvature 3, 4.
• Imaging modalities such as radiography, computed tomography (CT), and magnetic resonance (MR) imaging play important roles in the diagnosis, monitoring, and management of scoliosis 3.

Steps for Diagnosing Scoliosis

• The forward bend test and scoliometer measurement can be used to detect adolescent idiopathic scoliosis, with a Cobb angle of at least 10 degrees indicating scoliosis 5.
• Radiographs are critical in the initial evaluation of scoliosis, and additional imaging modalities such as CT or MR may be indicated if an underlying osseous or neurologic cause is suspected 3.
• The end vertebra angle can be used to describe the range of lateral deviation of a scoliosis, providing more detailed information than the Cobb angle alone 6.

Treatment of Scoliosis

• The treatment of idiopathic scoliosis is based on age, curve magnitude, and risk of progression, and includes observation, orthotic management, and surgical correction with fusion 2, 3.
• Bracing and scoliosis-specific physical therapy may be used to limit progression in mild to moderate scoliosis, but surgery is typically reserved for severe cases 5.
• The optimal follow-up interval for skeletally immature patients with idiopathic scoliosis may be as short as 4 months, with curves of more than 30° requiring ongoing monitoring after skeletal maturity is attained 3.