History

Social History

• Age:
  • How old are you?
• Education/Work:
  • Are you at school, college, or working? What is your job?
• Home Circumstances:
  • Who do you live with?
• Sports and Activities:
  • Do you play any sports or participate in physical activities?
• Career Aspirations:
  • What are your future plans or career goals?

Curve-Related Questions

• Onset:
  • When did you first notice the curve?
• Progression:
  • Has it gotten bigger?
• Impact:
  • Does the curve bother you, cause pain, or affect walking, sports, school, work, or social activities?
• Previous Medical Attention:
  • Have you seen anyone about it before? Have you received any treatment?

Associated Problems

• Neurologic Symptoms:
  • Do you experience any neurologic symptoms?
• Respiratory Symptoms:
  • Do you get short of breath?

Past Medical History

• Birth History:
  • Were there any issues during birth or the neonatal period (e.g., SCBU/NICU admissions)?
• Developmental Milestones:
  • Were there delays in milestones?
• Maternal Perinatal Problems:
  • Any complications during your mother’s pregnancy?
• Other Medical Problems:
  • Have you been told about any other related conditions?
  • Are there other issues you haven’t discussed with a doctor?

Skeletal Maturity

• Menarche:
  • When was your first period?
• Parental Height:
  • How tall are your parents or older siblings?

Family History

• Any family members with similar conditions?

Drug History and Allergies

• Current medications and allergies.

Examination

Look (Standing)

• Front:
  • Shoulder, pelvic, ASIS, and waist asymmetry.
  • Leg length discrepancy.
  • Skin signs of spinal dysraphism (e.g., café-au-lait spots, hairy patches, neurofibromas).
• Side:
  • Sagittal alignment (normal cervical, thoracic, and lumbar spine curves).
  • Plumb line alignment (measured via X-ray).
• Back:
  • Coronal alignment (C7 to natal cleft deviation).
  • Define curve pattern (e.g., right thoracic or left lumbar flexible).
  • Rib hump (measure with scoliometer during Adams forward bending test).
  • Skin stigmata or scars.

Feel (Standing)

• Palpate for pain along the spine.
• Chest expansion (nipple level) – should be at least 7 cm.

Move (Standing)

• Assess range of motion (ROM) in all planes.
• Observe gait:
  • Pelvic tilt or shoulder dipping.
  • Short leg gait.
  • Trendelenberg gait.

Look (Sitting)

• Assess partial correction of the curve (indicates compensatory/flexible elements).

Look (Lying)

• Measure leg lengths (apparent and true discrepancy).

Feel (Lying)

• Perform a full neurologic examination:
  • Reflexes.
  • Abdominal reflexes.
  • Upper Motor Neuron (UMN) signs (Babinski, clonus).

Move (Lying)

• Assess ROM of joints.

Finishing Steps

• Radiographs:
  • Obtain full-spine standing AP and lateral views.
• MRI:
  • If there are concerning features, order an MRI.

Scoliosis X-Ray Interpretation

Radiographs:

• Full spine (36-inch cassette), AP and lateral views, including hips.

Curve Assessment:

• Pattern:
  • Identify the type of curve.
• Cobb Angle:
  • Measure using the endplates of the most angled vertebrae.
• Apical Vertebra:
  • Note the most displaced vertebra.

Rotation:

• Assess pedicles for rotation.
• Determine whether spinous processes are visible between pedicles.
• Identify whether curves are structural (malrotation in both curves).

Congenital Anomalies:

• Look for hemivertebrae or bars.

Skeletal Age:

• Check iliac crest ossification and triradiate cartilage closure.

Flexibility:

• Forward-bending views to assess curve flexibility.