Scoliosis is sometimes associated with other conditions such as Ehler-Danlos Syndrome(hyperflexibility, 'floppy baby' syndrome, and other variants of the condition), Charcot-Marie-Tooth,kyphosis, cerebral palsy, spinal muscular atrophy, familial dysautonomia, CHARGE syndrome,Friedreich's ataxia, proteus syndrome, Spina bifida, Marfan's syndrome, neurofibromatosis,connective tissue disorders, congenital diaphragmatic hernia, and craniospinal axis disorders (
,syringomyelia, mitral valve prolapse, Arnold-Chiari malformation).
Patients who initially present with scoliosis are examined to determinewhether there is an underlying cause of the deformity. During a physicalexamination, the following is assessed:
Skin for café au lait spots indicative of neurofibromatosis
The feet for cavovarus deformity
Muscle tone for spasticityDuring the exam, the patient is asked to remove his shirt and bendforward (this is known as the Adam's Bend Test and is often performedon school students). If a hump is noted, then scoliosis is a possibility andthe patient should be sent for an x-ray to confirm the diagnosis.Alternatively, a scoliometer may be used to diagnose the condition.
The patient's gait is assessed, and there is an exam for signs of otherabnormalities (
, Spina bifida as evidenced by a dimple, hairy patch,lipoma, or hemangioma). A thorough neurological examination is alsoperformed.It is usual when scoliosis is suspected to arrange for weight-bearing full-spine AP/coronal (front-back view) and lateral/sagittal (side view) xraysto be taken, to assess both the scoliosis curves and also the kyphosis andlordosis, as these can also be affected in individuals with scoliosis. Full-length standing spine X rays are the standard method for evaluating theseverity and progression of the scoliosis, and whether it is congenital oridiopathic in nature. In growing individuals, serial radiographs are obtained at 3-12 month intervalsto follow curve progression. In some instances, MRI investigation is warranted.The standard method for assessing the curvature quantitatively is measurement of the Cobb angle,which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermostvertebrae involved and the lower endplate of the lowest vertebrae involved. For patients who havetwo curves, Cobb angles are followed for both curves. In some patients, lateral bending xrays areobtained to assess the flexibility of the curves or the primary and compensatory curves.Mass-screening for scoliosis using posture photosIt has been suggested that entire populations be examined, for early detection. For example, in the1940s, American psychologist William Sheldon proposed mandatory physical examinations thatincluded nude photographs of each person being examined. One purpose of these photographs wasthe detection of rickets, scoliosis, and lordosis. His approach was implemented at a number of ivyleague schools in which all freshmen were examined (Ivy League nude posture photos). A similarprogram was implemented in Boston's prison system.
Cobb angle measurementof a levoscoliosis
Page 3 of 7Scoliosis - Wikipedia, the free encyclopedia10/5/2009http://en.wikipedia.org/wiki/Dextroscoliosis