The typical medical scoliosis x-ray film taken is a supine Anterior to Posterior which will exclude the cervical spine. This film is incorrect. Spinal biomechanics dictate that when a spinal curve (cervical lordosis) is lost in one position, it will compensate and put that necessary curve in another dimension (Cobb angle). The first task should be to evaluate the loss of cervical and lumbar lordosis on lateral x-ray films.
The majority of Scoliosis patients have Anterior Head Syndrome and a loss of the cervical lordosis. There may be an Occiput or Atlas flexion malposition in the active, developing stage of the Scoliosis.
To determine the Cobb Angle the measurements require using the two most tilted vertebrae (this is an objective, not a subjective, decision). There should be a horizontal line drawn on the top of the superior vertebral body and a horizontal line on the bottom of the inferior vertebral body. A perpendicular line will be drawn (90 degrees) inferior and superior on the vertebral body lines. Then the Cobb Angle is measured at the intersection. Any Cobb angle over 10 degrees is medically considered a Scoliosis.
If any of my patients has a left lumbo-dorsal curve and a right thoracic curve that are roughly 5 to 10 degrees, it is taken seriously and treated aggressively, as a progression of even minor curves occurs more often than not.
Most medical practitioners and even most chiropractors don’t bring to attention another aspect of scoliosis to evaluate on x-rays are any abnormal spinous rotation. Lateral flexion and rotation of the spine are a coupled motion. In the upper dorsal spine of a non-scoliotic patient, the spinous’ should move into the convexity during lateral bending. However, in the scoliotic spine, the spinous’ will move into the concavity, which goes against normal spinal biomechanics. This abnormal rotation reduces adverse mechanical tension on the spinal cord and usually happens above 30 degrees.
As Primary Healthcare Providers and Spinal Experts, the Doctor of Chiropractic is in the best position to do early screening for Scoliosis. The early diagnosis makes treatment of this neuro-muscular disease much easier.
Remember if you have any questions feel free to give us a call. 252-758-7583
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9) Dr. Art Copes, anecdotal reference.
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