When it comes to diagnosing scoliosis, the process starts with a future patient, or someone in their lives, suspecting the presence of a spinal condition. Knowing the early signs of scoliosis to watch for can help lead to early detection, reaching a diagnosis, and the initiation of treatment.
The process of how to diagnose scoliosis can start at home with a person noticing signs of the condition, or are diagnosed during a routine physical. Next, a doctor would take the patient’s history and conduct a physical exam. If further indicators are found, a scoliosis X-ray would be ordered; the X-ray results would determine whether or not the stipulations for a scoliosis diagnosis have been met.
To better understand the process of how scoliosis is diagnosed, let’s first look at some defining characteristics of the condition. Then we will move on to exploring the diagnostic process in adolescents and adults.
When a person develops scoliosis, this means their spine has an abnormal sideways curvature. Scoliosis is a 3-dimensional condition, meaning that a scoliotic spine doesn’t just bend abnormally, but also rotates.
The spine doesn’t just bend forwards or backwards, to the left or right; it also bends, curves, and rotates in different directions.
Scoliosis can range greatly in severity from mild to moderate and severe to very severe. Scoliosis is also progressive, meaning it’s in its nature to worsen over time, if left untreated.
When it comes to cause, the main form of the condition, adolescent idiopathic scoliosis (AIS), has no single known cause, hence the ‘idiopathic’ designation; this form is, instead, generally considered to be multifactorial, meaning caused by multiple factors that can vary from patient to patient.
AIS account for 80 percent of known cases, and the remaining 20 percent have known causes such as congenital, neuromuscular, degenerative, and traumatic.
While scoliosis is far more common amongst children and adolescents, adults can develop the condition too; the two forms that affect adults are degenerative and idiopathic.
So in our discussion of how to diagnose scoliosis, I’ll run through a typical scenario of how an adolescent with scoliosis could find their way to a diagnosis, and how that process could differ for an adult.
Early detection of a medical condition is beneficial in most situations, but when it comes to progressive conditions, it’s particularly true.
Ideally, teenagers should be screened for scoliosis at least once a year. As AIS is not often a painful condition, it’s unlikely a teenager or adolescent would complain about discomfort or pain, which means it’s up to the parents and/or caregivers to be proactive.
As adolescence can also be the time when children become less transparent and more private, parents have to pay extra close attention to what is happening in their lives and bodies.
While receiving a scoliosis diagnosis is not exactly good news, when it happens sooner than later, it gives your child the best possible chance of treatment success and living a life that is not limited by their condition.
Catching AIS early means there are fewer limits to what we can do treatment-wise. It also means the body has not had time to fully adjust to the abnormal spinal curvature, making the spine and body more responsive to treatment.
Most importantly, if we reach a diagnosis early, this means we can start proactive treatment, meaning we can work towards managing progression so patients don’t have to face the hardships of further progression.
In adolescents, the most obvious telltale signs of scoliosis include changes to posture, symmetry, and the appearance of the hips, shoulders, shoulder blades, and back. In addition, clothing that used to fit, but seems suddenly ill-fitting, is also a sign to be aware of.
So what would the process look like for a teenager whose mother notices a suspicious asymmetry to their child’s body? The diagnostic process would start when a noticed indicator reveals the need for further testing.
While this is a hypothetical example, this is a typical scenario that could lead to an AIS diagnosis.
Let’s say, Sarah, a 13-year-old girl, is on vacation with her mom. They’ve opted for an all-inclusive beach resort and are spending a lot of time in bathing suits. One day at the pool, Sarah’s mom is watching her dive and marveling at how much she’s grown.
When Sarah is poised to dive into the pool in a forward-bend position, her mom notices that Sarah’s shoulder blades seem asymmetrical, with one protruding noticeably more than the other; she makes a mental note to take a closer look later.
When they are back at the hotel getting ready for dinner, Sarah’s mom asks Sarah to bend forward in that same position, and she again notices that her shoulder blades seem asymmetrical, something she hadn’t noticed before the trip, and also that the spine doesn’t seem 100-percent straight.
Fast forward to after they’re home from vacation and Sarah’s mom makes an appointment with their family doctor. The general practitioner sits down with Sarah and her mom and inquires as to her medical history.
Next, the doctor conducts a physical exam, observes how Sarah walks, and performs an Adam’s forward bend test. Sarah’s mom notices how the 90-degree bend forward at the waist is similar to the position Sarah was in when she first noticed the postural changes.
The doctor uses a Scoliometer and runs it along Sarah’s spine. The doctor explains that the scoliometer measures the angle of trunk rotation (ATR): a defining characteristic of scoliosis.
The doctor finds enough indicators for the condition to warrant further testing and orders a scoliosis X-ray; now, we are getting into the heart of the diagnostic process. From the X-ray results, Sarah will be told how severe her condition is and which section of the spine is affected.
The scoliosis X-ray tells us what we need to know to determine if structural scoliosis is present, in addition to important characteristics about the patient and their condition.
The most important piece of information provided by the scoliosis X-ray is the patient’s Cobb angle; this is a measurement taken from the most tilted-vertebrae of the curvature. Lines are drawn from the tops and bottoms of the vertebrae, and the intersecting lines form an angle measured in degrees.
In order for a scoliosis diagnosis to be reached, a patient has to have an abnormal spinal curvature that includes rotation and has a minimum Cobb angle measurement of 10 degrees.
In addition to determining if a spine is misaligned enough to be considered a true scoliosis, a patient’s Cobb angle also places the condition on its severity scale.
Part of the diagnostic process involves classifying the condition, and a patient’s Cobb angle is a big part of that. Other than the patient’s age, the scoliosis X-ray tells us everything we need to know to fully classify, diagnose, and treat the condition.
The patient’s age, condition cause (if known), condition severity, and location of the curvature all factor into the classification of a patient’s condition and their final diagnosis.
While there are similarities in the process of how scoliosis is diagnosed in adolescents and adults, there are some important differences, especially in how symptoms of the condition are experienced.
As mentioned earlier, there are two main forms of scoliosis in adults: degenerative and idiopathic.
The big difference in the diagnostic process between adolescents and adults is how the condition is first noticed, as this is what brings people in for an official diagnosis.
In adolescents, as it’s not a painful condition, early detection can be a challenge, especially as mild forms rarely produce functional deficits or noticeable postural changes, at least not to an average person who isn’t trained in what to look for; this is why it’s so important for parents and/or caregivers to educate themselves on the condition’s subtle early signs.
In adults, the most noticeable scoliosis symptom is pain. Scoliosis-related pain and discomfort can be felt in the back, shoulders, neck, head, and can radiate into the legs and feet.
Most commonly, it’s radiating pain felt in areas of the body, other than the back, that bring adults in to see me.
AIS isn’t painful because people who have not yet reached skeletal maturity have spines that are constantly growing and lengthening, counteracting the compressive force of the abnormal curvature; in adults who have reached skeletal maturity, scoliosis can be painful because the compression is felt by the spine and its surrounding nerves, vessels, and muscles.
In degenerative scoliosis, the spine has become misaligned because of degeneration due to aging and/or the cumulation of certain lifestyle choices.
Most commonly, it’s the intervertebral discs that are affected, and as the discs help give the spine support, flexibility, and help it to evenly distribute mechanical stress, when the discs start to erode, the spine is no longer able to support its natural and healthy curvatures, leading to the development of scoliosis.
Idiopathic Scoliosis in Adults
Idiopathic scoliosis is the more common form of adult scoliosis, and these patients are cases of AIS that were undiagnosed in adolescence and progressed into maturity.
With idiopathic scoliosis in adults, it’s not until the condition has progressed into skeletal maturity that it starts to produce noticeable symptoms such as pain.
Unfortunately, had these patients reached a diagnosis and gotten treatment during adolescence, their spines would be in very different shape than they are by the time they come to me; however, it’s never too late to start treatment and work towards an improvement.
This is part of the reason scoliosis is often described as ‘complex’ because it’s not always easy to diagnose, and the condition itself can vary so much in terms of severity, experienced symptoms, and how noticeable its symptoms are.
While the methodology behind the diagnostic process, in terms of physical examination, scoliosis X-ray, and Cobb angle/rotation stipulations are the same in adolescents and adults, how the condition is first noticed is a defining difference.
While adolescents will likely notice their condition due to postural changes that become more overt with progression, in adults, it’s pain that most often alerts them to the fact that something is amiss.
When it comes to diagnosing scoliosis, through the process of taking a patient’s history, conducting a physical exam, often including an Adam’s forward bend test, and the scoliosis X-ray, we can determine if a person has scoliosis.
In order for structural scoliosis to be diagnosed, the patient has to have an abnormally-curved spine that rotates and has a Cobb angle measurement of 10+ degrees.
If the above parameters are met, the condition is diagnosed and treatment can be started. While early detection doesn’t guarantee successful treatment outcomes every time, it does give us the best possible chance of designing and implementing the most effective treatment plan.
The big challenge to diagnosing the condition’s most common form (AIS) is early detection. As the condition isn’t painful and the postural changes it produces can be mild and difficult to notice, the majority of my adolescent patients are in the moderate-scoliosis stage; this is because it’s after the condition has progressed beyond mild levels that AIS symptoms tend to become more noticeable.
It’s the challenge of reaching early detection in adolescents that leads to adults being diagnosed with idiopathic scoliosis once skeletal maturity has been reached, making the condition painful and noticeable.
In degenerative scoliosis, it’s, again, pain that most commonly leads to a diagnosis in adults.
While the steps that bring adolescent and adult patients in for a diagnosis differ in terms of experienced signs and symptoms, once they are in my office, the methodology behind reaching a diagnosis is similar: discussing the patient’s medical history, conducting a physical exam/Adam’s forward bend test, and the findings provided by the scoliosis X-ray.
Here at the Scoliosis Reduction Center, regardless of age, we start treatment as close to the time of diagnosis as possible; this way, our patients can experience the potential benefits of early detection.