Scoliosis X-Ray Films

The typical medical scoliosis x-ray film taken is a supine Anterior to Posterior which will exclude the cervical spine. This film is incorrect.  Spinal biomechanics dictate that when a spinal curve (cervical lordosis) is lost in one position, it will compensate and put that necessary curve in another dimension (Cobb angle).  The first task should be to evaluate the loss of cervical and lumbar lordosis on lateral x-ray films.

The majority of Scoliosis patients have Anterior Head Syndrome and a loss of the cervical lordosis.  There may be an Occiput or Atlas flexion malposition in the active, developing stage of the Scoliosis.

This lateral curve MUST be corrected first to allow the Scoliosis to move back into place.

To determine the Cobb Angle the measurements require using the two most tilted vertebrae (this is an objective, not a subjective, decision).  There should be a horizontal line drawn on the top of the superior vertebral body and a horizontal line on the bottom of the inferior vertebral body.  A perpendicular line will be drawn (90 degrees) inferior and superior on the vertebral body lines.  Then the Cobb Angle is measured at the intersection.  Any Cobb angle over 10 degrees is medically considered a Scoliosis.

If any of my patients has a left lumbo-dorsal curve and a right thoracic curve that are roughly 5 to 10 degrees, it is taken seriously and treated aggressively, as a progression of even minor curves occurs more often than not.

Most medical practitioners and even most chiropractors don’t bring to attention another aspect of scoliosis to evaluate on x-rays are any abnormal spinous rotation.  Lateral flexion and rotation of the spine are a coupled motion.  In the upper dorsal spine of a non-scoliotic patient, the spinous’ should move into the convexity during lateral bending.  However, in the scoliotic spine, the spinous’ will move into the concavity, which goes against normal spinal biomechanics.  This abnormal rotation reduces adverse mechanical tension on the spinal cord and usually happens above 30 degrees.

As Primary Healthcare Providers and Spinal Experts, the Doctor of Chiropractic is in the best position to do early screening for Scoliosis.  The early diagnosis makes treatment of this neuro-muscular disease much easier.

Remember if you have any questions feel free to give us a call. 252-758-7583

References:

1) “U.S. Preventative Services Task Force issues on scoliosis screening policy,” Am Fam Physician, 1993 Jun;47(8):1876-7.

2) “The estimated cost of school scoliosis screening,” Spine, 2000 Sep 15;25(18):2387-91, Olmsted Medical Center, Rochester, MN.

3) “Detection of adolescent idiopathic scoliosis,” Acta Orthop Belg. 2006 Apr;72(2):184-6 Ali Fazal M, Edgar M.

4)  “Ten year follow-up evaluation of a school screening program for scoliosis.  Is the forward-bending test an accurate test in accurate diagnostic criterion for the screening of scoliosis?”  Karachalios, et al, Spine, 1999 Nov 15;24(22):2318-24.

5) “Prediction of scoliotic Cobb angle with the use of the Scoliometer,” Spine, 1996 Jul 15;21(14):1661-6.

6) “Detection of adolescent idiopathic scoliosis,” Ali Fazal M, Edgar M. Department of Orthopaedics, University College Hospital and The London Clinic, London, United Kingdom, Acta Orthop Belg. 2006 Apr;72(2):184-6.

7) “Scoliosis screening of 3,000 college-aged women: the Utah Study – Phase 2,” Brigham Young University, Provo, UT, Francis RS. Phys Ther 1988 Oct;68(10):1513-6.

8) “Thoracic Scoliosis and restricted neck motion: a new syndrome?” Floman, Hadassah University Hospital, Eur Spine J (1998) 7 : 155-157.

9) Dr. Art Copes, anecdotal reference.