A SPINAL DEFORMITY, idiopathic scoliosis is characterized by lateral and rotational curvature of the spine. It's often detected in children and adolescents during the period of rapid growth between ages 9 and 16. Although scoliosis screening has limitations, the potential benefits associated with early identification and treatment can be substantial.
* Obtain informed consent from the parent or legal guardian.
* Obtain the patient's health history, specifically asking about family history of spinal deformity, age of menarche (if appropriate), and pain.
* Provide privacy during screening. Ensure that the room is warm and adequately lit.
* Have a boy strip to the waist, wearing only loose pants or gym shorts. A girl should wear a swim top or sports bra and shorts or loose pants. Or a patient gown may be worn, if available.
* Ask her to remove her shoes and loosen her waistband if necessary so you can see her waistline.
* Instruct her to stand erect 5 to 8 feet (150 to 240 cm) away, with her back to you. As in the figure on the left, make sure her feet are slightly apart, knees straight, and weight evenly distributed on both feet. Her arms should dangle relaxed at her sides. Assess her in the standing and bending positions, from the back, front, and side, observing for the following:
asymmetrical positioning of her head in relation to her shoulders and pelvis
difference in shoulder height or arm lengths or uneven scapulae
unequal distance between her arms and body
hunched forward shoulders or accentuated swayback
accentuated prominence of the thoracic and lumbar spine or of the buttocks
uneven hip heights and waist creases or lateral curvature of the spine
difference in leg lengths greater than 1/2 inch (1.25 cm).
* Perform the Adams forward bend test as shown in the figure on the right: With the patient's feet together, knees straight, chin to chest, and hands together, have her bend forward from the waist 90 degrees. Observe for the following:
asymmetry of the rib cage or upper back or lumbar prominence
excessive kyphosis (curving of the spine that causes bowing of the back and a hunchback posture)
head not directly over her feet or her body twisting to one side.
* Document your assessment findings in her medical record. If any findings were abnormal, notify her parents or legal guardian and instruct them to follow up with their pediatrician. Suggest scoliosis screening for the patient's siblings.
* Don't screen boys and girls together.
* Don't expose body parts unnecessarily.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and answers about scoliosis in children and adolescents. 2008. http://www.niams.nih.gov/Health_Info/Scoliosis/scoliosis_qa.pdf.
Mehlman CT. Idiopathic scoliosis. Updated July 1, 2008. http://www.emedicine.com/orthoped/topic504.htm.
Scoliosis Research Society (2008). Screening for idiopathic scoliosis in adolescents. http://www.srs.org/professionals/positions/school_screening.php.
Standards for Scoliosis Screening in California Public Schools. Sacramento, CA: California Department of Education; 2007.