Initial pre-referral workup

Clinical history

Standard medical history.

Physical examination

Look for shoulder/trunk/waist asymmetry, for rib or lumbar asymmetry on forward bend and  for leg length discrepancy, which may be the cause of the scoliosis.

Investigations

• Patient should have a standing x-ray of their complete spine both PA and lateral to assess for abnormal curvature. If in the Greater Melbourne area, it is preferable to get an EOS scan as this will have reduced radiation for the patient.  EOS is available at the RCH, Bridge Rd Imaging, and Mulgrave Private Hospital and all EOS sites are bulk billed.

GP management

Curve less than 10 degrees is not considered scoliosis and can be managed as a normal variant in the spine.

Indications for specialist referral

All patients require an X-ray demonstrating abnormal spinal curvature prior to referral.

Routine

• under 13 years of age  –  cobb angle greater than 10 degrees
• age 13 to 17 – cobb angle greater than 20 degrees
• age older than 17 – not suitable for the RCH, send to adult institution

Any scoliotic curve in a patient under 18 with an underlying condition (i.e. neuromuscular condition, chromosomal/genetic abnormality, etc).