From the Guidelines
To evaluate for scoliosis and kyphosis, begin with a thorough physical examination, including the forward bend test, and use standing posterior-anterior radiographs to measure the Cobb angle, with scoliosis defined as a lateral curvature exceeding 10 degrees, and lateral spine radiographs to evaluate kyphosis, with normal thoracic kyphosis ranging from 20-45 degrees 1.
Key Components of Evaluation
- Perform the forward bend test (Adam's test) to observe for asymmetry in the back
- Use a scoliometer to measure the angle of trunk rotation, with readings greater than 7 degrees warranting further evaluation
- Standing posterior-anterior radiographs are essential for diagnosis, allowing measurement of the Cobb angle
- For kyphosis evaluation, observe the patient's side profile for excessive rounding of the upper back and measure the kyphotic angle using lateral spine radiographs
Importance of Imaging
- Radiography is the primary imaging modality employed for diagnosing and classifying scoliosis, evaluating severity, monitoring progression, and characterizing response to treatment 1
- MRI may be necessary if neurological symptoms are present or if structural abnormalities are suspected, particularly in patients with congenital scoliosis, early onset idiopathic scoliosis, and adolescent idiopathic scoliosis with certain risk factors 1
Screening and Intervention
- Regular screening is particularly important during adolescent growth spurts when these conditions can progress rapidly
- Early detection allows for timely intervention, which may include observation, physical therapy, bracing, or in severe cases, surgical correction
- The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for specific clinical conditions, including the evaluation and management of scoliosis and kyphosis 1
From the Research
Evaluation of Scoliosis and Kyphosis
To evaluate for scoliosis and kyphosis, the following steps can be taken:
- Medical history: taking a thorough medical history to identify any underlying conditions that may be contributing to the deformity 2, 3
- Clinical examination: performing a physical examination to assess the deformity and check for any neurological problems 4, 3
- Radiographic evaluation: using imaging studies such as X-rays, stereo-radiography, and surface topography to determine the curve type and magnitude 2, 4, 3
- Quality of life questionnaires: using questionnaires to evaluate the disability related to scoliosis and assess the patient's quality of life 4
Specific Evaluation Techniques
Some specific evaluation techniques that can be used include:
- Scoliometer: a device used to measure the curvature of the spine 4
- Classical radiography: used to determine the curve type and magnitude 4
- Ultrasounds, computer tomography, and magnetic resonance imaging: used in precisely defined clinical situations to assess for neurologic compromise and for surgical planning 4, 3
- Full-length standing posteroanterior and lateral spine radiographs: used to assess the deformity and measure pelvic parameters 3
Considerations for Evaluation
When evaluating for scoliosis and kyphosis, the following factors should be considered:
- Etiology of the deformity: whether the deformity is idiopathic or due to an underlying condition 2, 5
- Presence or absence of vertebral anomalies: whether there are any abnormalities in the vertebrae that may be contributing to the deformity 5
- Symptoms: whether the patient is experiencing any symptoms such as back pain or respiratory problems 2, 3
- Magnitude of the curve: the severity of the curvature of the spine 2, 4, 3
- Physiologic/skeletal age: the patient's age and stage of development 5
- Evidence of and risk of progression: whether the deformity is likely to progress and cause further problems 2, 5