Idiopathic Scoliosis

Adult

Imaging Studies

Front and side full-length standing X-rays that include all segments of the spine as well as the pelvis and hips are essential in the diagnostic evaluation of adults with spinal deformity (Figure 1A and B). From such X-rays the segmental alignment, regional curvatures and global balance (overall alignment) can be measured. It is important that the hips and knees are straight for the side X-rays to truly understand the deformity (Figure 1C and D). Focal imaging studies may be necessary to assess for instability (flexion-extension radiographs). Advanced imaging studies (such as MRI or CT myelography) may be needed to assess patients with lower extremity symptoms or other neurologic signs or symptoms (Figure 2).

A and B) Front and side X-rays showing the entire spine and hips. C and D) Make sure the knees and hips are straight on the side X-rays. (C) shows the patient in the compensated (knees bent) position, while (D) shows them standing with their knees straight.

Figure 1: A and B) Front and side X-rays showing the entire spine and hips. C and D) Make sure the knees and hips are straight on the side X-rays. C) shows the patient in the compensated (knees bent) position, while (D) shows them standing with their knees straight.

Figure 2: A) A front view of the lumbar spine. Yellow arrows show “olisthesis” (advanced rotation) and green arrows show tight regions causing pinched nerves. B) Myelogram – with the introduction of dye, the nerves can be seen on X-ray. The blue arrow shows a “dent” – pinched nerve blocking the dye. C) MRI of L4-L5 showing spinal stenosis (pinched nerves). D) CT myelogram of the same level. Without myelogram contrast, it is difficult to see nerves on CT.

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