Measurements for Scoliosis of the Spine

Measurements for Scoliosis of the Spine

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Scoliosis measurements guide treatment decisions. Images

Scoliosis of the spine -- a condition in which the spine curves side-to-side -- is often noticed in children around the time of puberty. Because children that age grow quickly, it's possible for scoliosis to progress just as quickly. Close monitoring ensures that proper treatment can be initiated when necessary. Consistent and reliable methods of measuring scoliosis are necessary to determine appropriate treatment strategies. X-ray measurements are especially important.

Postural Measurements

Often scoliosis is first suspected by a parent or an observant teacher who notices an asymmetry in the posture of a growing child. This observation frequently leads to a more formal postural evaluation by a school nurse, pediatrician or chiropractor. In this examination, the clinician will ask the child to bend forward at the waist to see if the rib cage is more elevated on one side. Uneven ribs suggest that the spine may be twisting as well as curving. Some clinicians measure the slope of the rib cage with a device called a scoliometer. Scoliometer measurements are useful as screening tools, but need to be supplemented by other measurements to guide treatment decisions.

Curve Measurements

Scoliosis is usually described in terms of degrees. Measurements of spinal curves are made on x-rays by identifying the top and bottom vertebrae of a curve and measuring the angle between them. A spinal curvature may be described as having a certain "Cobb angle" because the measuring method was named for orthopedic surgeon, John Cobb. Accurate assessments of Cobb angles are important because treatment strategies vary considerably based on the severity of the curve or evidence that the curve may be progressing.

Rotation Measurements

In addition to the side-to-side bending, most scoliosis curves have a rotational, or twisting, element. Clinicians may describe the rotation of a curve as grade 1 to grade 4 depending on the severity. The potential for organ crowding or compromised lung capacity is greater with severely rotated scoliosis curves. Knowing the severity and the progressive tendency of the rotation is also important when treatment by bracing is considered. The type and design of the brace depends, in part, on the amount of rotation in the curve.

What the Numbers Mean

Specific treatment recommendations are guided by measurements gathered while monitoring a child's scoliosis over time. Guidelines published in the journal "Scoliosis" recommend conservative approaches, which may include mobilization and exercise, for those whose curves are less than 20 degrees. Bracing may be recommended for growing patients with curves above 20 degrees who demonstrate progressive deformity or elevated risk of worsening. Surgery is generally reserved for those with curves exceeding 45 degrees. Curves of this magnitude can cause crowding of organs and compromised function of the heart and lungs.