Diagnosis and check-ups

Examination

Your doctor looks at the level of the shoulders, shoulder blades and waist, and uses a device called a scoliometer to measure any hump on the back during the forward bending test. Reflexes, muscle strength and sensation are also checked.

X-rays and the Cobb angle

Scoliosis is diagnosed on a full-spine X-ray taken standing, and the size of the curve is measured as the Cobb angle. Measuring the same X-ray at different times can give results a few degrees apart, so an increase of more than 5 degrees is usually needed before a curve is considered to have truly progressed.

During growth, X-rays are usually repeated every 4–6 months. To reduce radiation, back-to-front (PA) views and low-dose imaging systems may be preferred.

How much growth is left?

The risk of a curve progressing is closely linked to how much growth remains. Your doctor assesses this using age, the rate of growth in height, the date of the first period in girls, and bone maturity.

Bone maturity is graded from the appearance of the growth cartilage on the pelvis (Risser stage 0–5) or from a hand X-ray (Sanders stage 1–8). Lower stages mean more growth is still to come.

When is an MRI needed?

Most cases of typical adolescent scoliosis do not need an MRI. An MRI of the spinal cord and its surroundings may be requested for curves that start at a young age, thoracic curves that bend to the left, significant pain, signs involving the nervous system on examination, or unexpectedly rapid progression.