Scoliosis FAQ • What Is Scoliosis? • What Causes Scoliosis? • How Does the Doctor Diagnose Scoliosis? • Does Scoliosis Have To Be Treated? What Are the Treatments? • Are There Other Ways To Treat Scoliosis? • Which Brace Is Best? • If the Doctor Recommends Surgery, Which Procedure Is Best? • Can People with Scoliosis Exercise? • What Are Researchers Trying To Find Out About Scoliosis? • Where Can People Get More Information About Scoliosis?

The doctor takes the following steps to evaluate a patient for scoliosis:

Medical history--The doctor talks to the patient and the patient's parent or parents and reviews the patient's records to look for medical problems that might be causing the spine to curve, for example, birth defects, trauma, or other disorders that can be associated with scoliosis.

Physical examination--The doctor looks at the patient's back, chest, pelvis, legs, feet, and skin. The doctor checks if the patient's shoulders are level, whether the head is centered, and whether opposite sides of the body look level. The doctor also examines the back muscles while the patient is bending forward to see if one side of the rib cage is higher than the other. If there is a significant asymmetry (difference between opposite sides of the body), the doctor will refer the patient to an orthopaedic spine specialist (a doctor who has experience treating people with scoliosis). Certain changes in the skin, such as so-called café au lait (coffee-with-milk-colored) spots, can suggest that the scoliosis is caused by a birth defect.

X-ray evaluation--Patients with significant spinal curves, unusual back pain, or signs of involvement of the central nervous system (brain and spinal cord) such as bowel and bladder control problems need to have an x ray. The x ray should be done with the patient standing with his or her back to the x-ray machine. The view is of the entire spine on one long (36-inch) film. Occasionally, doctors ask for more tests to see if there are other problems.

Curve measurement--The doctor measures the curve on the x-ray image. He or she finds the vertebrae at the beginning and end of the curve and measures the angle of the curve (see "Curve Patterns" picture). Curves that are greater than 20 degrees require treatment.

Doctors group curves of the spine by their location, shape, pattern, and cause. They use this information to decide how best to treat the scoliosis.

Location--To identify a curve's location, doctors find the apex of the curve (the vertebra within the curve that is the most off-center); the location of the apex is the "location" of the curve. A thoracic curve has its apex in the thoracic area (the part of the spine to which the ribs attach). A lumbar curve has its apex in the lower back. A thoracolumbar curve has its apex where the thoracic and lumbar vertebrae join (see "Normal Spine" picture).

Shape--The curve usually is S- or C-shaped.

Pattern--Curves frequently follow patterns that have been studied in previous patients (see "Curve Patterns" picture). The larger the curve is, the more likely it will progress (depending on the amount of growth remaining).

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases.