Scoliosis - Diagnosis

Inclinometer (Scoliometer). An inclinometer, also known as a Scoliometer, measures distortions of the torso. The procedure is as follows:

The patient bends over, arms dangling and palms pressed together, until a curve can be observed in the upper back (thoracic area).
The Scoliometer is placed on the back and measures the apex (the highest point) of the upper back curve.
The patient continues bending until the curve can be seen in the lower back (lumbar area). The apex of this curve is also measured.
Measurements are repeated twice, with the patient returning to a standing position between repetitions.
If results show a deformity, x-rays probably need to be performed to determine the extent.

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Some experts believe the Scoliometer would make a useful device for widespread screening. Scoliometers, however, indicate rib cage distortions in more than half of children who turn out to have very minor or no sideways curves. They are therefore not accurate enough to guide treatment.

Imaging Tests

Currently, x-rays are the most cost efficient method for diagnosing scoliosis. Experts hope that accurate, noninvasive diagnostic techniques will eventually be developed to replace some of the x-rays used to monitor the progression of scoliosis. To date, some under investigation appear to be fairly accurate for detecting scoliosis in the upper back (the thoracic region), but not scoliosis in the lower back (the lumbar region).

X-Rays. If screening indicates scoliosis, the child may be sent to a specialist who takes an initial x-ray and monitors the child every few months using repeated x-rays. X-rays are essential for an accurate diagnosis of scoliosis in that they:

Reveal the degree and severity of scoliosis.
Identify any other spinal abnormalities, including kyphosis (hunchback) and hyperlordosis (swayback).
Help the physician determine whether or not skeletal growth has reached maturity.
X-rays taken when patients are bending forward can also help differentiate between structural and nonstructural scoliosis. Structural curves persist when a person bends over, and nonstructural curves tend to disappear. (It should be noted that muscle spasms or spinal growths may sometimes cause nonstructural scoliosis that shows a curve on bending.)
In children and young adolescents who have mild curves and in older adolescents who have more severe curvatures but whose growth has stopped or slowed down, x-rays should be performed every few months in order to detect increasing severity. Young people who are diagnosed with scoliosis should be sure to keep their x-rays indefinitely in case they develop back problems later in adulthood and need to be re-examined.

Protective Measures for Frequent X-Rays

Because frequent x-rays may be required for young children with scoliosis, parents should be sure that x-ray technicians take all necessary protective methods. Experts are concerned about the long-term effects of radiation on sensitive young organs, particularly about a possible increase in the risk for cancer. Studies have reported an increased risk for cancer in women and men who, because of scoliosis, had been exposed to diagnostic x-rays in their childhood and adolescence.

X-ray techniques have become safer in recent years, and the hazards may be reduced with simple measures:

X-ray beams should be directed through the patient from back to front, rather than the reverse.
Filters for the x-ray tube are available that absorb some of the beam.
Fast film should be used, which can reduce exposure by two to six times.
Lead aprons or shields should always be worn over parts of the body that are not being x-rayed.