When is the right time to screen for scoliosis?

There are variety of different guidelines, but it is wise to add the Adams forward bend test to your well visits starting at age 9-10 for girls, and 11-12 for boys. It should only take about 10 seconds. If there is a family history of scoliosis, you might even want to start a year or two earlier.

What do I look for during the exam?

On the Adams forward bend test, use your scoliometer to detect thoracic or lumbar rotation. Also look at trunk shift or shoulder imbalance (although both of these can be caused by other factors such as leg-length inequality).

What findings warrant a referral?

The generally accepted guideline is to refer when the scoliometer reads 7°. Recently studies, including one done at Children’s Hospital of Philadelphia, have shown that scoliosis is increasingly being missed in obese children. In some cases, scoliosis that measures over 40° presents with a scoliometer reading of only 7° in an obese child. Therefore, refer obese children with the scoliometer reading of 5°, or an overweight child with a reading of 6°.

Should I order an X-ray rather than refer for PE findings?

Many primary care physicians prefer to order an X-ray first, and if the Cobb angle on the X-ray measures more than 10-15°, then scoliosis evaluation by a pediatric orthopedist is recommended. At CHOP, we certainly support this practice, but consider ordering an X-ray done with an EOS machine, where radiation doses are an order of magnitude less than conventional imaging. CHOP is one of the few hospitals in the country to have two EOS machines (one at CHOP Main Building, and one at CHOP Specialty Care, King of Prussia). 

What if I am really worried about the PE findings?

Occasionally, a patient will present to you with a very obvious spinal deformity. Perhaps they were not conscientious about coming for well visits. There are also cases where a huge growth spurt over the past year will cause scoliosis to progress extremely quickly, leading to a big change in the physical exam from year to year.

If you are really concerned about your physical exam findings, we can almost always see the child within a few days, and get X-rays on site as part of their visit. Don’t hesitate to call or email if you have questions or concerns about severe scoliosis in a patient.