Symptoms, diagnosis and evolution of scoliosis

Often asymptomatic, scoliosis must be systematically screened in children and adolescents. If the disease is detected, x-rays are used to clarify the diagnosis, then to follow the evolution of the curvatures of the spine.

SCOLIOSIS: WHAT SYMPTOMS?

Idiopathic scoliosis of children and adolescents most often develops gradually during growth. It usually develops slowly before puberty and then accelerates during puberty. Usually the child does not complain. This is why a systematic back inspection is recommended once a year in children and adolescents. Indeed, the earliest possible detection of scoliosis is essential for good medical management.

Adults with scoliosis sometimes complain of low back pain. However, this disease is asymptomatic most of the time. Only a medical examination can detect it.

THE DIAGNOSIS OF SCOLIOSIS

Scoliosis: a thorough examination of the back to detect scoliosis, the doctor conducts a medical examination of his patient. The back inspection consists of several steps: The person is measured standing and possibly lying down. She then stands, shirtless, and joins her two bare feet. The doctor then looks for a possible asymmetry of the fold of the waist or shoulders, the first signs of scoliosis. The patient, still standing, leans forward, hands clasped, head down and legs extended. The doctor looks at the back to look for gibbosity (bulge-shaped deformation of the back) in the upper thorax (or more rarely in the lumbar vertebrae). The doctor examines the child or teenager to find out what stage of his physical development he is (growing period, puberty). If scoliosis is present, the doctor continues his observation by a complete examination (neurological, orthopedic...) In search of a disease or malformation that could deform the spine (or "spine"). X-rays to confirm the diagnosis of scoliosis and assess its severity. If, at the end of the consultation, scoliosis has been detected, the doctor requests additional examinations to confirm the diagnosis: x-rays of the entire spine, front and profile. They allow: to make the diagnosis of scoliosis: the spine is bent on the side, there is a kyphosis (convex deformation of the back) and a rotation of the vertebrae, assess the extent of existing deformities: extent of scoliosis, vertebrae concerned, measure the amplitude of the major spine curve, expressed in degrees and called Cobb’s angle. This is the angle formed by the upper and lower vertebrae of scoliosis, to look for a possible cause (vertebral malformation, supernumerary vertebra...), to follow the evolution of scoliosis over time. Left hand and wrist x-rays, elbow in children and pelvic x-rays in adolescents to determine bone age (degree of bone maturation relative to age) depending on the case and the treatment envisaged, other tests may be necessary: CT, MRI, respiratory functional tests if scoliosis is important enough to affect the ability to breathe… Scoliosis and the angle of Cobb Diagram explaining how to calculate the Cobb angle in case of scoliosis.

HOW DOES SCOLIOSIS EVOLVE?

The evolution of scoliosis is assessed several times a year by the Cobb angle measurement, and this evolution conditions the treatment. Progressive scoliosis is when: the child’s idiopathic scoliosis increases during puberty, to the point that the curvature of the spine (Cobb’s angle), initially at least 15° increases by 5° between two radiographs at 4 or 6 months apart; the spine curvature is immediately greater than 30°, regardless of the age of the person affected.

In general, in adults, scoliosis is often stabilized. However, it can still evolve, more slowly than in adolescence. Finally, for women, scoliosis sometimes worsens at menopause (especially if it affects the lumbar area). During this period, the drop in hormonal levels (in estrogens) can be responsible for osteoporosis and weakens the bone. Important scoliosis can have other consequences: a decrease in breathing capacity due to chest deformation; an aesthetic impact (deformation of the body, loss of height) and psychological, sometimes painfully experienced by the patient and altering his quality of life on a daily basis.