Once you find out you have scoliosis, you will begin having x-rays to see what your curve looks like and then to check on your curve and see if it has changed. A lot of big decisions are made based on your x-rays, so it's completely normal to get a little nervous when you go in for another x-ray. On this page, we hope to answer some of your questions about x-rays and help you feel more comfortable with the x-ray process.
Why do I need x-rays?
X-rays allow your healthcare team to see what your spine looks like. With x-rays, your healthcare team can see what your curve looks like and watch how it changes over time. How your curve looks on the x-ray plays a big part in what treatment your doctor recommends. With x-rays, your doctor is also able to estimate how much growth you have left.
How do x-rays work?
X-ray beams pass through your body, but they cannot be seen with your eyes. The x-ray breams are absorbed by the different parts of your body. Because your bones are more dense, they show up as white on x-rays, which allows your medical team to clearly see your backbones, or vertebrae. Your medical team is then able to measure your curve and to approximate how much growing you have left to do. Keep reading to find out how your doctor measures your curve and how they figure out how much growth you have left.
What is your Cobb angle?
Your Cobb angle is a measure of the curvature of your spine in degrees. This measurement helps your doctor determine what type of treatment is necessary. In order to be diagnosed with scoliosis, your Cobb angle must be at least 10 degrees.
The Cobb angle helps your doctor and orthotist track your scoliosis to see if your curve is progressing. Progressing is another way of saying getting larger. The Cobb angle is measured using your x-ray. Your medical team with use the most tilted vertebra (backbone) at the top of your curve and the most tilted vertebra at the bottom of your curve to measure your Cobb angle.
The apex of your curve is the the vertebra that is the farthest away from the middle of your body. Because your x-ray is used to measure your Cobb angle, it is very important to bring your most up-to-date x-rays to your appointments with your orthotist.
Why is your Cobb angle important?
Your Cobb angle plays a big role in what treatment your doctor recommends. The below information gives you an idea about what treatment is typically recommended for different Cobb angles. Your specific curve and situation will be taken into consideration by your doctor when he or she recommends a particular treatment.
- Curves under 20 degrees are normally observed, unless your curve has a high risk of progression (progression is another way of saying that your curve is getting larger).
- Curves around 25 degrees are normally treated with bracing.
- Curves larger than 50 degrees may need to be treated with surgery.
Your current Cobb angle is also important because it will be compared to your older x-rays to determine if your curve is staying the same, progressing, or improving.
What is your Risser sign?
You may hear your doctor talk about your Risser sign when he or she is looking at your x-ray. The Risser sign helps doctors figure out the risk of your scoliosis getting worse, or progressing. The Risser sign measures how much mature bone has developed on the top part of your hip bones.
You can be classified as Risser 0 - 5. Risser 0 means that the bone hasn't started to grow on top of your hip bones yet, so you still have a lot of growing to do. On the other hand, Risser 5 means that the all of new bone has developed and has fused to your hip bone, so you are close to done growing. Doctors use the Risser sign because for the most part, if you are growing, your curve is growing. If you still have a lot of growing to do, we want to make sure that we do everything we can to keep that curve from growing, too.
Bracing is an effective way to keep your curve under control as your grow. However, because bracing affects the growing spine, it will not help very much or help at all if you are done growing and skeletally mature. If you are almost done growing and are a Risser 4 or 5, your curve is probably close to done growing, too, so bracing may not be the best option.
What do "thoracic" and "lumbar" mean?
The terms "thoracic" and "lumbar" refer to different regions of your spine. You have a total of 33 vertebrae, or backbones. You have 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused sacral vertebrae, and 4 fused coccygeal vertebrae. Scoliosis most commonly occurs in the thoracic and lumbar vertebrae. The most common curve pattern is a right thoracic curve and a left lumbar curve.
If the apex of your curve is a thoracic vertebra, your curve will be classified as a "thoracic curve."
If the apex of your curve is a lumbar vertebra, your curve will be classified as a "lumbar curve."
If the apex of your curve is the last thoracic vertebra or the first lumbar vertebra, your curve will be classified as a "thoracolumbar curve."
What to do during your x-ray?
First, take a deep breath. It can be a bit stressful getting x-rays taken, so try and take a few breaths and relax. The x-ray tech will take you to the right spot and tell you what you need to do.
Depending on where you get your x-ray taken, you may have to lift your arms in front of you during the x-ray. This is especially common with the EOS Imaging machine. Try to keep the rest of your body still if you have to lift your arms. This will make sure that your x-ray is an accurate picture of your spine and scoliosis. If you lift your arms up and tilt your trunk over in one direction, your curves will look different in the x-ray, which makes it hard for your medical team to see what exactly is going on with your spine. As a general rule, try to stand tall while continuing to breathe and stay relaxed.
Are x-rays bad for you?
X-rays fall into the same category as candy, cake, and ice cream in that too much of a good thing is not a good thing. As a whole, x-rays are good because they help your healthcare team treat your scoliosis in the best way possible. Because of x-rays, your healthcare team does not have to guess about what is happening with your spine. With x-rays, they know what is happening and know how to treat your curve.
However, studies have shown that too many x-rays can increase your risk of health problems when you get older, so in general, we only want to do x-rays when they are necessary. X-ray technology has improved over time, so the risk of health problems is much much much lower than it used to be back in the old days.
How many x-rays is too many?
There is no simple answer to this question. The goal is to monitor your scoliosis with as few x-rays as possible but that may look different for each person. SOSORT, which stands for the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment, published these guidelines in 2012 about when to schedule x-rays based on your age and/or Risser:
- For patients 0–5 years of age with early onset scoliosis: every 6 months
- For patients 6–12 years of age with juvenile scoliosis: every 6 months
- For patients 13–18 years of age with AIS, Risser Stage 0–1: every 12 months
- For patients 13–18 years of age with AIS, Risser Stage 2–3: every 12 months
- For patients 13–18 years of age with AIS, Risser Stage 4–5: every 18 months
- For patients 19–30 years of age with AIS, Post-growth surveillance: every 24 months
SOSORT also recommends having a new x-ray if your clinical presentation changes. In other words, if you notice that your posture has become more uneven or your rib hump has gotten larger, then you should have another x-ray taken to see if your Cobb angle has also changed.
SOSORT also recommends getting an in-brace x-ray after you get fit with a new brace to see how it is working. To read the full article, click the button below.
What is EOS Imaging?
EOS Imaging is new technology that uses a low dose of x-ray beams to create the x-ray picture. The dose for EOS x-rays are reduced to between 1/6 and 1/9 of the standard dose. With EOS imaging, the risk of health concerns is further reduced. If you have EOS Imaging in your area, talk to your healthcare team about having your x-rays taken at an EOS facility.
Why on earth are they taking an x-ray of my left hand?
It may seem strange when your doctor orders a hand x-ray in addition to your spinal x-ray. Your hand isn't an issue, so why are we taking an x-ray of it? Recent research has found that looking at the growth plates in your hand (via x-ray) is a more accurate way of determining how much growth you have left. This approach and classification system is called the Sanders Classification. The classification ranges from 1 to 8 and is based on the growth plates in your hand and wrist.
Researchers are finding that this method of determining remaining growth and skeletal maturity is more accurate than the Risser sign, which is why many doctors are beginning to order hand x-rays.