Scoliosis Diagnosis and Treatment

Initial Assessment and Screening

• The American College of Radiology recommends the Adams forward bend test combined with scoliometer measurement for initial clinical screening, with the Adams test having a sensitivity of 84.37% and specificity of 93.44% 3
• Physical examination should assess for shoulder height asymmetry, neurological abnormalities, and skin examination for cutaneous stigmata that might suggest underlying spinal dysraphism 3

Radiographic Assessment

• The American College of Radiology recommends upright PA and lateral spine radiographs as the primary imaging modality for diagnosing and classifying scoliosis 1, 2, 4
• Serial PA spine radiographs are essential for monitoring progression, with frequency determined by skeletal maturity 1, 2
• Limit spine radiographs to once every 12 months for patients at Risser stages 0-3 and every 18 months for patients at Risser stages 4-5 to reduce radiation exposure 1

Documentation Requirements

• Red flags requiring urgent evaluation include left thoracic curve, short segment curve, absence of apical segment lordosis/kyphosis, rapid curve progression, functionally disruptive pain, focal neurological findings, and male sex 3, 4

Advanced Imaging

• MRI is indicated for patients with congenital scoliosis, atypical curves or neurological findings, and presurgical planning 4
• CT may be preferred for presurgical planning, visualization of bony malformations, and characterization of osseous septum in type I split cord malformations 1, 2
• Low-dose protocols should be used when CT is necessary 4

Treatment Algorithm Based on Curve Magnitude

• Curves 20-40° in skeletally immature patients have a >70% likelihood of progression, and bracing should be considered 1, 2
• Curves >50° in adolescents and young adults typically require surgical intervention 5

Monitoring Progression

• Skeletally immature individuals with Cobb angles >20° have >70% likelihood of curve progression 1, 2
• Skeletally mature patients with thoracic scoliosis >50° may continue to progress at approximately 1° per year 1

Common Pitfalls to Avoid

• Absence of neurological symptoms does not rule out intraspinal abnormalities, particularly in congenital scoliosis 1, 2, 4