INVESTIGATION AND

TREATMENT
Nurnadiah elina bt Akberdin
bms15091787
Investigation
• Conventional x-ray
- Proper assessment of scoliosis( full antero- posterior X-ray of the
spine)
- Cobb’s angle
- Reisser’s sign
- Estimation of vertebral rotation
1. Evaluation of lateral curvature
- Major curvature: highest deviation from the perpendicular
- Minor curvatures: compensatory deviations from the midline above
and below the major curvature
2. cobb’s angle
- Perpendicular to a line drawn across the superior endplate of the
highest affected vertebra
- Perpendicular to a line drawn across the inferior endplate of the
lowest affected vertebra
1. Locate the most tilted vertebra at
the top of the curve and draw a
parallel line to the superior vertebral
end plate.
2. Locate the most tilted vertebra at
the bottom of the curve and draw a
parallel line to the inferior vertebral
end plate.
3. Erect intersecting perpendicular
lines from the two parallel lines.
4. The angle formed between the two
parallel lines is Cobb angle
3. Estimation of vertebral rotation (Nash and Moe method): assessment
of the position of the vertebral pedicles is relation to the vertebral
bodies.
4. Evaluation of skeletal maturity based on lateral ossification of the
apophysis across the iliac crest (Risser sign) → relevant for prognosis.
5. Lateral bending imaging of the spine : evaluation of curve flexibility
MANAGEMENT
• Treatment based on the Cobb angle:
- Cobb angle < 10°: per definition not scoliosis, and therefore not
monitored
- Cobb angle 10–19°: continual monitoring for progression
- Cobb angle 20–29°: monitoring or bracing
- Cobb angle 30–39°: bracingCobb angle > 40° or rapidly progressing
scoliosis: surgery
• Bracing:
- 18 hours/day if possible
- Bracing is usually able to halt progression, but cannot cure the
underlying condition.