There are many people who do not have a good grasp on what scoliosis, I see it all the time, a patient who was once told they have a scoliosis but upon examination I find none. Understanding the process of diagnosing scoliosis is important, not just for patient education, but also so clinicians best understand what specific criteria is required. Not all curves in the spine can be classified as a scoliosis but all scoliosis’ involve a curve in the spine.
A scoliosis can only be diagnosed by taking a standing radiograph (x-ray). While a postural examination can give us an indication who might have a scoliosis, it is not definitive. The screening exam we do is looking at someones posture from the front and side as well as looking at the back while the patient is bending over. In a true, large scoliosis the rib cage rotates as the spine curves creating a hump in the back that is, sometimes, best viewed with the patient bending over. Again, these are just screening tools and not specific enough to diagnose a scoliosis.
From the front the spine should be straight and it is most accurate to measure this on a standing radiograph. Standing is important because it is the only position that give us an accurate view of the curve in a gravity environment. A standing view is the only position that gives us an accurate view of the spine in the patients everyday normal posture. A laying down view removes gravity from the picture and does not give us an accurate view of the spine. Sitting, while keeping the spine under axial loading, removes what effect the foot – knee- hip – pelvis may have on the curve. Sometimes a patients curvature is either in part or in whole due to a true short leg. Without a standing radiograph we could not determine if that is a possibility. A true short leg causes the pelvis to tilt towards the short leg side and the spine then angles that direction but at some point angles back towards neutral.
With that standing radiograph we do a specific measurement to determine if the curve seen is an actual scoliosis. The standard measurement is called a Cobb angle. We take this measurement using the vertebrae at the top of the curve and another at the bottom. When the Cobb angle measures over 10 degrees we call the curve a scoliosis, under 10 degrees is not. Outside of this we also have to understand other postures the can occur in the spine, that might look like a scoliosis but are not. These primarily include translations of the spine. In a translation the spine is shifted towards one side but there is not large curvature nor is there rib humping seen on the patients posture. I have had several patients over the years present saying they have a scoliosis but under examination I find a translation instead. I believe this is an error with some clinicians confusing any deviation from normal in the spine as a scoliosis.
A scoliosis can only be diagnosed by standing radiographs, looking at the spine from the anterior to the posterior or front to back. On that radiograph there should be a real curve measuring greater than 10 degrees Cobb angle. Not all deviations from normal posture, from the front, are a real scoliosis. A posture exam can be a great screening tool but should never be used as the sole means for diagnosis. If you, or your child, has ever been told they have a scoliosis after just a posture exam you were told wrong.
If you are worried about the possibly of yourself or your child having a scoliosis you will find most chiropractors are equipped to help investigate this for you. I recommend finding a Chiropractic BioPhysics trained chiropractor. If you are in the Geneva, IL area give our offie a call I would be happy to help you determine the presence, or absence, of a scoliosis.