Scoliosis is a sideways curve of the spine with rotation of the vertebrae, most often idiopathic and appearing in adolescents during growth. Small curves are only watched, while larger curves in growing children may need a brace or surgery.
Key symptoms
- Uneven shoulders, waist or hips noticed by family
- Rib hump when bending forward
- Clothes hanging unevenly
- Usually painless in teens; back pain is more common in adults
What you find on exam
- Adams forward bend test with a scoliometer
- Shoulder, shoulder blade and pelvic height
- Neurologic exam: strength, reflexes, abdominal reflexes
- Skin for cafe-au-lait spots or a midline hair tuft; growth stage
Tests
- Standing full-spine X-ray to measure the Cobb angle (10 degrees or more)
- Risser sign on X-ray to judge remaining growth
- MRI if the curve is painful, left thoracic or fast-progressing, or the neuro exam is abnormal
Treatment basics
- Curves under 25 degrees: observation with repeat X-rays during growth
- Brace for 25 to 40 degrees in a still-growing child
- Spinal fusion surgery for curves over 45 to 50 degrees
- Exercise and physical therapy to support posture and core strength
Red flags
- Significant back pain or night pain in a teen with a curve
- Weakness, numbness, abnormal reflexes or bladder changes
- Rapid curve progression or breathing difficulty with a severe curve
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.