Scoliosis = curvature of the spine in the coronal plane which can be accompanied by a variable degree of rotation of the spinal column.
It is diagnosed clinically and radiographically in a child greater than 10 years of age, with a curvature of the spine in the coronal plane with Cobb angle ≥ 10 degrees, and the absence of other etiologies for scoliosis.
Idiopathic scoliosis is more common in females than males. The X-ray that you get should be Posterior-Anterior (PA), not AP. Why? To reduce radiation to the breast because many of these kids will get many chest X-rays. It should also be a whole spine X-ray that shows both cervical, thoracic, lumbar, and pelvic bones.
“Idiopathic scoliosis is scoliosis for which there is no known etiology. The patients usually present for evaluation as a result of truncal asymmetry noted by the patient or parents, during school-based scoliosis screening, or as an incidental finding on a physical examination or on X-ray.”
“The patient is examined using the Adams forward bend test by observing from the back while the patient bends forward at the waist. A sign of scoliosis is the thoracic or lumbar prominence on one side.”
A scoliometer is then used where measurements can help in determining which patients need radiographs. Indications for radiographs include scoliometer reading ≥7 degrees, clinically evident scoliosis on examination, and thoracic or lumbar asymmetry found in skeletally immature children.
Radiographs are required to confirm the diagnosis of scoliosis, evaluate the etiology, determine the Cobb angle, and to evaluate skeletal maturity.
At what age is spinal examination most important? Approximately 10 years of age (before the pubertal growth spurt).