Progression Patterns
The rate of deformity development is directly related to the child's growth rate. The more actively the skeleton grows, the more rapidly the condition of the spine can deteriorate.
- Peak of deterioration: occurs during the pubertal growth spurt (11–13 years in girls and 14–16 years in boys).
- Deceleration: occurs by ages 17–20, when bone growth is completed.
- General rule: an early onset of the disease threatens a severe clinical course, whereas a later start rarely leads to pronounced changes.
The exception is paralytic scoliosis (e.g., after poliomyelitis) — it can progress even in adult patients after the growth plates have closed.
Objective examination of the patient
For an accurate assessment of the deformity, the physician marks bony landmarks: spinous processes, scapular angles, clavicles, iliac crests, and the jugular notch. The examination includes three positions:
- Sitting: pelvic tilt, severity of lumbar lordosis, and lateral deviation of the trunk are checked.
- Standing: asymmetry of the shoulder girdles, scapulae, and clavicles is assessed. On the concave side of the curve, the scapula shifts closer to the spine, and the distance from C₇ to the inferior angle of the scapula becomes smaller on the convex side. A plumb line test from the C₇ spinous process is used to measure axis deviation. The presence of a rib hump, leg length discrepancy, and joint mobility are also evaluated.
- Lying down: in the supine position, abdominal muscle tone is checked; in the prone position, the degree of correction of the primary and compensatory curves is evaluated.
Assessment of Deformity Stability
The longer the curvature persists, the more fixed it becomes. Several tests are used to check scoliosis stability:
- Spinal traction (head pulling).
- Trunk bending to the left and right.
- Side-lying positioning (on the side of concavity).
- Manual pressure on the convex part of the curve.
- Radiological control.
X-ray Diagnostics and Classification
Radiography is the gold standard and a mandatory method for confirming the diagnosis. Images are taken in two projections (frontal and sagittal) in standing, lying, and bending positions. This makes it possible to assess changes in the curve under load and identify bone anomalies.
To determine the severity of the disease in domestic practice, V.D. Chaklin's classification is used, based on measuring the angle of curvature:
- Grade I: angle up to 10°, initial vertebral torsion.
- Grade II: angle from 11° to 25°.
- Grade III: angle from 26° to 40°.
- Grade IV: angle greater than 40°.
Radiograph analysis determines further patient management tactics and the prognosis of the disease.
Briefly: answers to topical questions
What clinical and radiological signs are characteristic of Grade I scoliosis according to Chaklin?
Grade I scoliosis according to Chaklin is characterized by a lateral deviation of the spine from the vertical axis of up to 10° and an initial degree of torsion.
Radiological signs:
- Lateral deviation — the angle of curvature is up to 10°.
- Vertebral torsion — the spinous processes are not located on a straight line, but form a spiral due to moderate rotational displacement of each vertebra relative to the previous one.
What radiological signs indicate the completion of bone growth in scoliosis?
The completion of bone growth is indicated by the complete fusion of the growth plate with the iliac bone according to the Risser sign.
Radiologically, the ossification of the iliac wing (Risser stages) shaped like a sickle is evaluated. The stages of apophysis development are:
- Stage I — appearance of ossification centers.
- Stage II — development of ossification centers to the middle of the iliac wing.
- Stage III — complete coverage of the iliac wing.
- Stage IV — complete fusion of the ossification centers with the main bone.
It is the onset of Stage IV that indicates the cessation of the child's growth.
How to differentiate between primary and compensatory curves in scoliosis?
To differentiate between primary and compensatory (secondary) curves, their mobility, the magnitude of the curvature angle, and the presence of torsional changes are evaluated.
Criteria for a structural curve:
- Loss of mobility — assessed during radiography with functional tests, including side bending.
- Torsional changes — the presence of vertebral body rotation.
The compensatory curve forms in the opposite direction to maintain the body's vertical axis. The secondary curve may be non-structural or structural. The degree of correction of primary and compensatory curves is determined by examining the patient in the prone position.
What methods for measuring the spinal curvature angle are used on radiographs?
On radiographs, the Cobb method is used to measure the angle of spinal curvature in the frontal and sagittal planes.
Stages of measurement using the Cobb method:
- Identification of end vertebrae — identifying the upper and lower neutral vertebrae of the curve without signs of rotation.
- Drawing lines — straight lines are drawn along the cranial endplate of the upper vertebra and the caudal endplate of the lower vertebra (or through the margins of the pedicle shadows).
- Constructing perpendiculars — perpendiculars are dropped onto the drawn lines.
The angle formed at the intersection of these perpendiculars determines the magnitude of the scoliotic curve.
Class and exam questions
At what age does scoliosis progress the fastest?
Maximum progression coincides with the pubertal growth spurt: in girls, this is the period of 11–13 years; in boys, 14–16 years.
How is lateral spinal deviation assessed during examination?
A plumb line test is used: a weighted thread is attached to the skin over the spinous process of the seventh cervical vertebra (C₇), and the deviation of the underlying vertebrae from the vertical is measured in centimeters.
Why does a rib hump form in scoliosis?
With a curvature in the thoracic region, the deformed vertebrae twist and pull the ribs attached to them, which leads to persistent chest deformity.
What else to study on this topic
- Plumb line test technique
- Method for calculating the curvature angle on radiographs
- Assessment of the functional state of abdominal muscles in scoliosis
- Systemic cardiac and pulmonary changes in congenital scoliosis
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