Scoliosis - Diagnosis

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The Cobb method is limited because it cannot fully determine the flexibility or the three-dimensional aspect of the spine. It is not as effective, then, in defining spinal rotation or kyphosis. It also tends to over-estimate the curve. Additional diagnostic tools are needed to make a more accurate diagnosis.

Classifying the Curve. Classification of the curve allows the doctor to identify patterns that can help determine treatments, particularly specific surgical techniques. The following are examples:

• King Classification. The King classification classifies scoliosis curves as one of five patterns, which can help determine surgical treatments. It has limitations, however, and is not very useful for advanced surgical techniques.
• Lenke Classification. Lenke classification takes more features of the curve into consideration and is proving to be more reliable. It includes six curve patterns plus additional factors that modify each of these curves.

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Three-Dimensional Modeling Techniques. Advanced computer modeling techniques are able to create three dimensional images using x-rays or other two-dimensional images. They allow doctors to observe the spinal distortions. Eventually, they could reduce the number of x-rays needed to monitor scoliosis and help surgeons determine the best surgical procedures.

Determining the End of Growth

Even if the curve is accurately calculated, it still remains difficult to predict whether the scoliosis will progress. In addition, computer models are being used to better predict risk. One approach requires measuring 21 radiographic and clinical indicators and entering them into a computer program. The technique takes less than 20 minutes per patient, and studies found it to be up to 80% accurate in determining progression of curvature.

One way of predicting whether or not the curvature will progress is knowing when the child will stop growing:

• If the child has years to grow, then the curve has more time to progress.
• If the child will stop growing within a year, then progression should be very slight. (However, some progression continues in nearly 70% of curves even after the spine has matured.)