When the Spine Curves: Treatments for Scoliosis

Present Knowledge of Scoliosis

School Screening Programs*

In order to alert children and their parents to the possibility of scoliosis, many public schools provide a school screening program for students. Although programs vary widely, girls are generally checked between 5th and 9th grade, and boys from 6th to 11th grade. Since boys mature later than girls and spinal curves may still increase, they are often screened for scoliosis until they are age 16.

School screening may identify scoliosis earlier in life when it is more manageable. When a curve is found before it becomes severe, physicians can use nonoperative treatment to stop the curve before it worsens.

• The ideal screening process is three-fold. First, an examiner does a posture analysis while the child is standing up straight. The shoulders and hips are checked for unevenness, the scapulae for any prominence, and the arms for uneven length. Unevenness in any of these areas can indicate scoliosis.
• The next part involves use of a device called a scoliometer. This hand-held measuring tool is placed on the middle of the back while the child bends over as if to touch her toes. It measures the angle across the back, revealing the possibility of abnormal curvature.
• The final step is known as the Adam's forward bend test. The examiner faces the child while she bends forward as if to touch her toes. The child allows her arms to hang loose and keeps her knees straight. Bumps or "humps" may be seen on either the right or left side of the back, and on the upper or lower back. In some cases, a bump on both sides of the back may be seen. These bumps can indicate scoliosis.

8. Posture during Adams Bending Test Thoracic curve of 83 degrees and lumbar of 43 degrees circa 1980 Courtesy of Weinstein, Stuart L., ed. The Pediatric Spine: Principle and Practice. Vol. I. New York: Raven Press, 1994.

9. Adolescent with scoliosis, standing up straight Thoracic curve of 83 degrees and lumbar of 43 degrees circa 1980 Courtesy of Weinstein, Stuart L., ed. The Pediatric Spine: Principles and Practice. Vol. I. New York: Raven Press, 1994.

Although referral patterns vary, if a child exhibits abnormalities on two or three of the above exams, an appointment with an orthopaedist is generally recommended.

* Currently mandatory in twenty-two states.