How Is Scoliosis Diagnosed? Key Steps Explained

Scoliosis is a highly prevalent spinal condition with close to seven million people diagnosed in the United States alone. Understanding its early signs can lead to early detection and intervention: factors directly related to treatment success.

There are a number of spinal conditions that cause a loss of its healthy curves, but some characteristics set scoliosis apart. Scoliosis is diagnosed through a physical examination and X-ray results that determine the patient's Cobb angle and confirm rotation in the spine.

Scoliosis isn't always easy to diagnose, and how a diagnosis of scoliosis is responded to with treatment will have long-term effects.

Understanding a Scoliosis Diagnosis

Being diagnosed with scoliosis means an unnatural spinal curve that bends to the side has developed, and as a progressive condition, its nature is to get worse over time.

As a progressive condition, scoliosis is incurable; scoliosis treatment is about how best to manage an ongoing condition.

All cases of scoliosis can benefit from treatment, particularly those that are diagnosed and treated early in its progressive line.

Scoliosis ranges in severity from mild scoliosis to moderate, severe and very severe scoliosis, and condition severity is determined by a measurement known as Cobb angle.

Cobb Angle and Condition Severity

Condition severity is classified based on a patient's Cobb angle measurement, and a parameter that has to be met to be considered a true scoliosis is a minimum Cobb angle of 10 degrees.

A patient's cobb angle is determined by drawing lines from the tops and bottoms of the curve's most tilted vertebrae, and the resulting angle is expressed in degrees.

The higher a patient's Cobb angle, the more severe the condition, and the further out of alignment the spine is.

• Mild scoliosis is diagnosed with a minimum Cobb angle of between 10 and 25 degrees
• Moderate scoliosis involves Cobb angle measurements of between 25 and 40 degrees
• Severe scoliosis is diagnosed at 40+ degrees, and very severe at 80 degrees

In addition to the minimum Cobb angle requirement involved in a diagnosis, a scoliosis X-ray also has to confirm the rotational component.

Scoliosis X-Ray: Rotation and Curvature Location

Scoliosis is a complex condition to treat; not only does it cause the spine to bend unnaturally to the side, it also has a rotational component, and this is confirmed during X-ray.

In addition to confirming the condition's 3-dimensional nature, the X-ray also tells us where in the spine the scoliosis has developed.

There are three main sections to the spine: the cervical spine, thoracic spine, and the lumbar spine.

Scoliosis can develop in any one section, or in more than one as a combined scoliosis: thoracolumbar scoliosis that develops in the upper lumbar spine and the lower thoracic spine is a common curve type.

Curvature location is important not only because it indicates where treatment efforts should be concentrated, but also because it predicts likely condition effects; in most cases, the area of the body located the closest to the affected spinal section is most likely to feel the condition's direct effects.

The direction of the curve is also important, and this is also part of diagnosing scoliosis, and condition type is determined by its underlying cause.

Diagnosing Different Types of Scoliosis

Part of the diagnostic process involves comprehensive assessment to classify conditions based on a number of key variables, and these factors shape customized treatment plans.

The most common type of scoliosis overall is idiopathic scoliosis, meaning not clearly associated with a single known cause.

Typical cases of idiopathic scoliosis feature right-bending curves that bend away from the heart, but in atypical types, curves can bend to the left, towards the heart, and when I see a left-bending curve on an X-ray, I know there is an underlying pathology causing the scoliosis to develop.

Scoliosis With Known Causes

While 80 percent of known cases involve idiopathic scoliosis, the remaining 20 percent are associated with known causes: neuromuscular scoliosis, degenerative scoliosis, and congenital scoliosis.

Neuromuscular scoliosis is caused by the presence of a larger neuromuscular condition such as spina bifida, muscular dystrophy, and cerebral palsy, and these types of cases can be severe because there is a larger condition causing the unnatural spinal curve as a related complication.

Degenerative scoliosis is caused by natural age-related spinal degeneration, and affects older adults and is more common in females than males due to hormone and bone density changes related to menopause.

Congenital scoliosis is caused by spinal malformations that develop in utero and is a rare type affecting 1 in 10,000.

Adolescent idiopathic scoliosis is the most prevalent type of scoliosis overall and is diagnosed between the ages of 10 and reaching skeletal maturity, and this age group is the most at risk for rapid progression due to the rapid and unpredictable growth spurts of puberty.

Scoliosis Treatment Options

Following a diagnosis of scoliosis, the most important decision to be made is how to treat the condition; treatment will shape the spine's long-term health and function.

Curve progression can be managed, but the timing of when treatment is started is important.

In most patients, it's more effective to proactively work towards preventing progression and increasing effects than it is to attempt to reverse effects once they're established.

There are three ways to respond to a diagnosis of scoliosis: treat it with surgery, with non surgical treatment, or leave it untreated. Let's touch on the highlights of each of these responses.

Surgical Treatment

Surgical treatment options including spinal fusion surgery, and like all surgery, it comes with its share of potential risks, side effects, and complications.

Spinal fusion fuses the curve's most tilted-vertebrae into one solid bone so they can't become more unnaturally tilted over time, and metal rods are attached to the spine to hold it in place.

While spinal fusion can straighten a bent spine, the way it does so is invasive and can cost the spine in its flexibility and range of motion, and a fused spine is weaker and more vulnerable to injury.

Scoliosis surgery comes with some real risks so should be considered carefully.

Non Surgical Treatment

Non surgical treatment is also known as conservative, functional, and/or chiropractic-centered.

Non surgical treatment values a proactive treatment response so is started as close to the time of diagnosis as possible when conditions are at their mildest and likely to be the most responsive.

Symptoms of scoliosis can be minimized with proactive treatment, and the treatment goal is to preserve as much of the spine's natural strength and function as possible, and the reality is that many patients don't need surgery, particularly with early detection and intervention.

Conservative treatment is integrative so combines the power of multiple treatment options: chiropractic care, physical therapy, corrective bracing, and rehabilitation.

Together, these treatment disciplines work together to improve the spine's structural alignment, increase the strength and balance of the spine's surrounding muscles for more support and stability, pushing the spine into a corrective position, and further healing and stabilizing the spine for long-term treatment results.

Here at the Scoliosis Reduction Center®, conservative treatment is applied to impact conditions on every level, and the Center's results speak for themselves.

Leaving Scoliosis Untreated

The last remaining response to a scoliosis diagnosis is leaving the condition untreated, and this can lead to complications in the future.

The nature of scoliosis is to get worse over time, so leaving it untreated can mean allowing it to progress unimpeded, and once a certain level of progression has occurred, non surgical treatment options are limited, leaving surgery as the remaining recourse.

Leaving scoliosis untreated can mean mild scoliosis becoming moderate, severe, or even very severe scoliosis over time.

Complications of leaving scoliosis untreated can include significant pain, digestive issues, lung impairment, nerve damage, muscle weakness, and cardiac issues.

Leaving scoliosis untreated can mean postural changes that are overt such as noticeable uneven shoulders, uneven shoulder blades, the development of a rib cage arch, one side of the rib cage protruding more, an uneven waist, and uneven hips.

Scoliosis progressing also disrupts gait, balance, and coordination, so changes to movement can also be overt in untreated scoliosis.

Conclusion

Childhood scoliosis should always be taken seriously due to progression being triggered by growth, and scoliosis is diagnosed through a physical examination that includes an adam's forward bend test, taking a family history, and performing a scoliosis X-ray; what's most important about a scoliosis diagnosis is how it's responded to with treatment.

An unnatural spinal curvature needs to be addressed because it's introducing uneven forces to the spine, its surroundings, and the entire body, and if left untreated, condition effects can become more overt and difficult to improve and/or reverse.

The more severe scoliosis becomes, the more likely a surgical recommendation is, and the procedure is risky and can disrupt the spine's natural strength and function.

If certain risk factors are present in children such as a family history, gender and age, scoliosis screening programs can help achieve early detection and treatment success.

Regardless of the type or severity of scoliosis at the time of diagnosis, the best time to start scoliosis treatment is always now.