Scoliosis is a disorder where the spine is curved laterally, or away from center, and is typically coupled with rotation of the vertebrae. Scoliosis strikes most frequently during adolescence - about 85% of scoliosis diagnoses. Onset during adolescence is known as adolescent idiopathic scoliosis or AIS. Idiopathic is defined as ‘no known cause’. Other types of scoliosis are named according to age of onset. Infantile scoliosis is diagnosed before three years of age and juvenile scoliosis between age three and nine or ten. Scoliosis, in some cases, may go undetected until a person is an adult. Generally, the earlier the onset of scoliosis, the higher the risk of curve progression.

Is It Scoliosis?

Scoliosis can often be determined by a visual examination from behind. When viewing the spine from behind, there is a lack of symmetry. Scoliosis is classified as mild, moderate or severe (more on this later) and depending on each unique case, may cause limited problems for the scoliosis sufferer, or many. The combination of lateral curvature and vertebral rotation often results in a “rip hump” in the thoracic spine. The occurs when spinal vertebrae rotate toward the concave side of the curve pushing the ribs dorsally (backwards) producing a prominence on the convex side of the spine. This prominence can be viewed from the rear when a person bends forward from the waist with the spine parallel to the floor with feet together, knees straight and arms hanging down. This is known as the Adam’s Forward Bend Test. Physicians should perform other tests, including x-rays, to determine if scoliosis is present.

Cobb Angle Measurement: Scoliosis is measured in degrees by a measurement known as a Cobb angle.  Any measurement under 10º is not considered to be scoliosis. To find the Cobb angle measurement, a line is drawn from the top edge of the upper “apical” vertebra (the spinal bone with the most displacement and tilt) and also from the bottom of the lower “apical” vertebra. “In a normal spine this procedure will yield two parallel lines, with an angle of ‘0.’ In scoliosis, the vertebrae are tilted according to the severity of the curvature. For any given curvature, the vertebrae at the top and bottom of the curve are the most tilted and are used as a basis for the Cobb angle measurement.”¹ The Cobb angle is the universal standard to diagnose scoliosis and to assess whether a curvature has stabilized or is getting worse.² However, the Cobb angle is an imperfect measurement and there is significant debate on the degree required to determine whether a curve is getting better or worse. Generally the margin of error in Cobb angle measurement is considered to be 5º.

With scoliosis, the spine must be considered from a lateral (side) view as well. From a lateral perspective a normal spine has four curves: cervical, thoracic, lumbar and sacral. Scoliosis frequently presents with deviations in the typical lateral curve patterns. For instance, it is normal for the thoracic spine to have a slight arcing C pattern (kyphosis), but with scoliosis there may be a deviation from normal: if the arc is especially pronounced, it may be hyperkyphosis - an increase of kyphosis. If there is a flattening of the thoracic spine, the patient may have hypokyphosis. The lower back or lumbar spine should have an inverse “C” mild arc know as lordosis, but an above normal variation of the curve pattern in the low back is known as hyperlordosis. If there is a flattening in the lumbar spine this is known as hypolordosis. These variables in the way scoliosis presents contributes to making each scoliosis case unique and requires the expertise of a scoliosis specialist. A majority of scoliosis patients are hypokyphotic in the thoracic spine and hypolordotic in the lumbar spine.

¹, ³ Hawes, Martha C., Ph.D., Scoliosis and the Human Spine: A critical review of clinical approaches to the treatment of       

        Spinal deformity in the United States, and a proposal for change., Tuscon, Arizona: West Press, 2003.

   ²  Moe’s Textbook of Scoliosis and Other Spinal Deformities, Third Edition, eds Lonstein J, Bradford D, Winter R, Ogilvie J, WB            

       Saunders, Philadelphia.

Mild, Moderate or Severe:

“Scoliosis is generally classified as mild (10-24º) Cobb angle measurement, moderate (25-50º) and severe >50º with some quantitative variation among sources, depending on the perspective of the author of any given article.”³

*Information contained on this site is for informational purposes only. It is not meant for diagnosis. You must consult a physician for a medical opinion.

Indicators suggesting scoliosis may be present:

1. ✴Spinal asymmetry
   

2. ✴Unlevel shoulders
   

3. ✴Shoulder blades that protrude more on one side or the other, or are elevated
   

4. ✴Unlevel hips, with or without hip prominence to one side
   

5. ✴The head does not line up in a straight line with the pelvis
   

6. ✴Rib Hump

Information

Scoliosis Terminology

Things to Know Before Visiting Your Scoliosis Doctor