By Dr. Tim Fargo, Chiropractor
The term “scoliosis” denotes a lateral (sideways) curve of the spine with rotation. That rotation can be visible in the muscles surrounding the spine, and also in the ribs that attach to the spine. The most common form of scoliosis is known as “idiopathic”. Idiopathic scoliosis is a form which has no other known cause and is especially concerning when it afflicts young people who are still growing. If you, your child, or someone you know has scoliosis, then you should also be aware that there are particular “red flags” that require special attention. A red flag is a warning of danger. When we are talking about red flags in scoliosis it is because these particular features may signal underlying disease processes and/or may indicate a high risk of progression (getting worse). In years of clinical practice I have seen many cases where obvious red flags have been missed or ignored by other clinicians.
The following red flags always require additional follow-up in order to rule out more severe underlying conditions or disease processes:
- Primary left thoracic (mid back) and/or right lumbar (low back) curves in adolescents. Idiopathic scoliosis is, by definition, of unknown cause. The fact that most idiopathic scoliosis cases have right thoracic and left lumbar curves is equally as inexplicable. When you see a left thoracic or right lumbar curve it is essential to further explore whether there might be, for example, spinal cord issues or other pathology. Usually an MRI is required, and it should encompass the area where the skull meets the upper neck.
- Acute pain is not common in scoliosis in teenagers. It is relatively common for teenagers with scoliosis to have low-grade, chronic back pain, but acute pain is something that must be investigated further.
- Night pain. Whenever an adolescent is experiencing night pain associated with scoliosis we must be concerned about the potential for underlying spinal pathology.
- Scoliosis in boys. Scoliosis is far less common in boys than it is in girls and when you see scoliosis in a young boy you must be aware that it is more often associated with pathology.
- Early onset presentation. When you see scoliosis in someone before the age of 10 it is an immediate red flag. The concern in such a case is that there is a higher risk of underlying pathology and also of progression.
While it is true that every scoliosis case should be properly evaluated, it is all the more important that such evaluation be done when one of the above red flags is present. One way to think about the above red flags is that when you see them, and there is any doubt about underlying conditions, then an MRI should be done. There is an old expression that “forewarned is forearmed”. It is my hope that greater familiarity with these red flags will help in the decision-making required with adolescent scoliosis.