Scoliosis (AIS)

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?

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.
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