Article Text
PDF
Statistics from Altmetric.com
Recent advances in imaging technology have resulted in a better understanding of the complexities of the scoliotic spine. Plain radiography remains the usual method of measuring curvature progression, but use of multiplanar imaging techniques, such as computed tomography and magnetic resonance, have resulted in a greater understanding of the three dimensional nature of scoliosis and enabled underlying abnormalities to be detected with confidence.
Key messages
-
Careful clinical evaluation, including a full physical and neurological examination, is essential
-
Subtle signs should not be ignored
-
The most common form is seen in girls over 10 years, is idiopathic, thoracic, or thoraco-lumbar and convex to the right, with normal physical and neurological examination
-
Plain radiography remains the primary imaging modality for the initial diagnosis and follow up to assess curve progression
-
Any child not conforming to the typical form of scoliosis, either by age criteria, history, or clinical examination requires further investigations with magnetic resonance imaging (MRI)
-
Ideally, any child in whom surgery is contemplated should have MRI
-
The spine should be imaged from the craniocervical junction to the sacrum
Painful scoliosis
-
A painful scoliosis always requires thorough investigation
-
A bone scan is often helpful in young children who cannot adequately localise the pain
-
Targeted cross sectional imaging should be performed if a focal abnormality is identified
Congenital abnormalities
-
MRI should be performed to assess dysraphism and other congenital abnormalities
-
Congenital bony abnormalities of the spine, such as hemivertebrae and butterfly vertebrae, might benefit from localised computed tomography to define bony detail
Clinical evaluation
Despite the advances in imaging capabilities, the initial detection of scoliosis relies on clinical skills. The prevalence of scoliosis is quoted as approximately 1–3% for curves of greater than 10°.1 A few are detected through school screening, some will be found incidentally when imaging is performed for other reasons, such …