Idiopathic scoliosis

At Children’s Hospital Boston, we know that the first step in treating your child is forming an accurate and complete diagnosis.

Even though doctors and some schools routinely screen for idiopathic scoliosis, the condition can be difficult to diagnose. Sometimes the curves are obvious, but other times they aren’t immediately visible. Since scoliosis curves often aren’t painful, and since they usually progress slowly, they can be overlooked until a child approaches puberty.

Because detecting and treating scoliosis early are important for successful outcomes, pediatricians, family doctors and even some school programs routinely look for signs that scoliosis may be present.

Once a problem is detected, doctors will use a medical and family history, physical exams and diagnostic tests to determine the nature and extent of your child’s scoliosis. Your doctor will review your child’s complete prenatal and birth history, as well as any family history of scoliosis.

During your child’s physical exams, her physician will be looking for, and measuring, abnormal contours that indicate scoliosis. Through physical exams and diagnostic testing, the doctor will determine the:

• shape of the curve (“S” or “C” shape; involvement of ribs and muscles)
• location of the curve (upper [thoracic] spine; lower [lumbar] spine; or both [thoracolumbar])
• direction of the curve (bend to left or right)
• angle of the curve in degrees (Cobb angle)

X-rays and other tests

X-rays (front and side) are the main diagnostic tools for confirming the presence of scoliosis, as well as the severity of the curve. To get more information, or if the doctor suspects that an underlying condition might be causing the scoliosis, additional tests can include:

• magnetic resonance imaging (MRI) (especially useful in assessing the spinal cord in many forms of scoliosis)
• computerized tomography scan (CT or CAT scan)
• blood tests
• ultrasound (sonogram) (especially useful in assessing the spinal cord in infants less than 6 months of age)
• bone scans
• bone density scans (dual-energy x-ray absorptiometry, DEXA, DXA)
• pulmonary function tests

The likely progression of an adolescent’s curves can often be predicted by assessing the magnitude of her existing curve(s), as well as her physiologic and skeletal maturity.