Screening
What is scoliosis?Scoliosis is a sideways curvature of the spine greater than 10 degrees, which is measured by the Cobb angle. Curvature less than 10 degrees is considered normal variation.
When should my child be screened for scoliosis?
There are variety of different guidelines, but the Adams forward bend test is typically added to well visits starting at age 9-10 for girls, and 11-12 for boys. If there is a family history of scoliosis, screening should begin earlier.
What happens during a screening test?
During scoliosis screening, the doctor looks for shoulder blade asymmetry, waistline asymmetry and trunk shift. On the Adams forward bend test, a scoliometer is used to detect thoracic or lumbar rotation, and the presence of any rib prominence is noted.
Can the Adams forward bend test be performed at home?
Yes, you can find instructions for performing the Adams forward bend test on Youtube, scoliometers can be purchased online, there are free scoliometer apps, and a scoliometer can even be made out of a water bottle. Any positive findings at home should be verified by your primary care provider, as they will need to provide a referral for imaging.
How accurate are scoliometer readings?
Scoliometer readings measure scoliosis rotation, also known as vertebral rotation, or angle of trunk rotation (ATR), and do not always correspond to Cobb angle. It is possible to have mild scoliosis with a large degree of rotation, or severe scoliosis with a small degree of rotation. Recent studies have also shown that scoliosis is increasingly being missed in obese children. In some cases, scoliosis that measures over 40 degrees presents with a scoliometer reading of only 7 degrees in an obese child. Imaging is required to confirm a diagnosis of scoliosis.
What findings warrant a referral?
The generally accepted guideline is to refer to X-ray imaging when the scoliometer reads 7 degrees or greater. For no-dose upright MRI, a scoliometer reading is not required for a referral.
Why is no-dose or low-dose imaging important for children with scoliosis?
For children and teens who require frequent imaging to monitor progress of scoliosis, multiple doses of radiation from standard X-rays results in an increase in their life-long radiation exposure. Increased radiation for scoliosis patients has been shown to increase the risk of developing cancer later in life, especially endometrial and breast cancer. Radiation-free or low-radiation imaging is therefore recommended for frequent monitoring of scoliosis in children and adolescents.
What if my child is not a patient at a no-dose or low-dose imaging facility?
You do not have to be a patient at the facility to have imaging done there. Contact the facility directly and they will provide you with a referral form for your pediatrician. For a list of no-dose and low-dose radiation facilities that provide upright scoliosis imaging, click here.
How long does no-dose or low-dose scoliosis imaging take? Are you standing up during imaging?
Imaging is done standing up (weight-bearing) and usually takes less than 5 minutes.
Incidence of cancer in adolescent idiopathic scoliosis patients treated 25 years previously. Simony A, Hansen EJ, Christensen SB, Carreon LY, Andersen MO. Eur Spine J. 2016 https://pubmed.ncbi.nlm.nih.gov/27592106
Scoliosis monitoring using traditional X-ray imaging may increase the risk of developing cancer up to 5 times. The overall cancer rate in this AIS cohort was 4.3 % which is five times higher than compared to the age-matched Danish population, and endometrial and breast cancer was most frequent. The radiation dose applied to the patients in this study, is comparable to modern equipment. This is to our knowledge the first study to report increased rates of endometrial cancers in a cohort of AIS patients, and future attention is needed to reduce the radiation dose distributed to the AIS patients both pre-operatively and during surgery.
Cancer and mortality risks of patients with scoliosis from radiation exposure: a systematic review and meta-analysis. Luan FJ, Wan Y, Mak KC, Ma CJ, Wang HQ. Eur Spine J. 2020 https://pubmed.ncbi.nlm.nih.gov/32852591
Based on 35,641 participants with over 20 years' observations from 1912 to 1990, repeated radiographs and pertaining cumulative radiation dose resulted in elevated rates of cancer, breast cancer and cancer mortality for children/adolescents with scoliosis in comparison with matched general population. It is recommended that low-radiation or radiation-free and efficient methods should be used to monitor the evolution of children/adolescents with scoliosis.