Classifying the Curve. Classification of the curve allows the doctor to identify patterns that can help determine treatments, particularly specific surgical techniques. The following are examples:
- King Classification. The King classification classifies scoliosis curves as one of five patterns, which can help determine surgical treatments. It has limitations, however, and is not very useful for advanced surgical techniques.
- Lenke Classification. Lenke classification takes more features of the curve into consideration and is proving to be more reliable. It includes six curve patterns plus additional factors that modify each of these curves.
Three-Dimensional Modeling Techniques. Advanced computer modeling techniques are able to create three dimensional images using x-rays or other two-dimensional images. They allow doctors to observe the spinal distortions. Eventually, they could reduce the number of x-rays needed to monitor scoliosis and help surgeons determine the best surgical procedures.
Determining the End of Growth
Even if the curve is accurately calculated, it still remains difficult to predict whether the scoliosis will progress. In addition, computer models are being used to better predict risk. One approach requires measuring 21 radiographic and clinical indicators and entering them into a computer program. The technique takes less than 20 minutes per patient, and studies found it to be up to 80% accurate in determining progression of curvature.
One way of predicting whether or not the curvature will progress is knowing when the child will stop growing:
- If the child has years to grow, then the curve has more time to progress.
- If the child will stop growing within a year, then progression should be very slight. (However, some progression continues in nearly 70% of curves even after the spine has matured.)
Knowing the child's age is, of course, the first step in estimating the end of growth. In addition, other methods can help predict the end of the growth stage. One method is called the Risser sign, which grades the amount of bone in the area at the top of the hipbone. A low grade indicates that the skeleton still has considerable growth; a high grade means that the child has nearly stopped growing and the curve is unlikely to progress much further. The Risser sign differs between genders, and, in boys, a high grade does not always signify the end of progression.
To Screen or Not to Screen for Scoliosis
Screening programs for scoliosis, which began in the 1940s, are now mandatory in middle or high schools in many states, but there is considerable debate over whether screening should be routine.
Arguments Against Routine Screening. The U.S. Preventive Services Task Force does not recommend routine screening to detect adolescent scoliosis for the following reasons:
Previous Section
Review Date: 04/06/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
