Imaging in scoliosis

Recent advances in imaging technology have resulted in a better understanding of the complexities of the scoliotic spine.Plain radiography remains the usual method of measuring curvature progression, but use of multiplanar imaging techniques, such as computed tomography and magnetic resonance, have resulted in a greater understanding of the three dimensional nature of scoliosis and enabled underlying abnormalities to be detected with confidence. Clinical evaluationDespite the advances in imaging capabilities, the initial detection of scoliosis relies on clinical skills.The prevalence of scoliosis is quoted as approximately 1-3% for curves of greater than 10°. 1 A few are detected through school screening, some will be found incidentally when imaging is performed for other reasons, such as during chest or abdominal radiography, and some will be identified because of a high degree of clinical suspicion in a child with known associated anomalies, such as VATER (vertebral, anorectal, tracheal, oesophageal, renal) complex.It is also important to remember that many neurological and neuromuscular conditions, such as cerebral palsy and spinal muscular atrophy, will produce scoliosis.Scoliosis is usually described in terms of the side of the convexity, and has been traditionally divided by age at presentation into four main groups: congenital, infantile (< 3 years old), juvenile (3-10 years), and adolescent (> 10 years).This classification forms a general framework for the subsequent imaging assessment of the child.Careful clinical evaluation, especially physical and neurological examination, plays a vital role in deciding how and when to image.Although 80% of scoliosis is idiopathic, there are clinical features that suggest an alternative diagnosis: a child with an abnormal neurological examination, a painful scoliosis, or other clinical signs of dysraphism will require more than plain radiographs (fig 1).Neck pain and headache, especially with exertion, and neurological findings such as weakness, pes cavus, and ataxia are also indications for further imaging.2 Back pain should be investigated promptly to exclude inflammatory processes, such as discitis, and the occasional primary bone neoplasm, such as an osteoid osteoma.Leg length discrepancy is a potent cause for postural scoliosis and might in itself require accurate measurement with computed tomography (CT) "scanograms".A rapidly