Important aspects of the history for adult patients with scoliosis

Historical feature	Potential significance
Scoliosis history
Onset of scoliosis	Onset after adolescence may indicate degenerative adult scoliosis Onset during adolescence may indicate progressive adolescent idiopathic scoliosis with secondary degenerative changes Variable onset: Scoliosis secondary to an underlying condition
Change in posture or balance	Patient-reported change in posture or trunk balance may indicate degenerative and/or fracture-related collapse or buckling of 1 or more intervertebral discs
Loss of height Ask how tall the patient was when they obtained their driver's license or graduated from high school and compare with current height	For patients ≥40 years, loss of height ≥0.5 inches per decade may indicate osteoporotic compression fracture or progression of scoliosis
Characterization of pain
Location	Axial pain (eg, cervical, thoracic, or lumbar region) may indicate the anatomic site of vertebral collapse Pain over scoliotic convexity may be related to muscle fatigue or spasm Radiation to the legs suggests radiculopathy or spinal stenosis
Severity/nighttime pain	Sudden severe pain or pain that awakens the patient at night may indicate neoplasm, fracture, infection, or other serious pathology that requires additional evaluation*
Aggravating/relieving factors (including previous treatments)	Pain caused by scoliosis is aggravated with exertion and is often relieved by lying supine or bracing (which eliminates or decreases the effect of gravity)
Associated symptoms
"Red flag signs" (eg, progressive weakness, clumsiness, or loss of bowel or bladder control – with or without numbness or shooting extremity pain)*	Suggests a neurologic cause and may require urgent evaluation and possible urgent decompressive surgery for cauda equina syndrome or myelopathy*
Isolated numbness or shooting extremity pain	Lumbosacral radiculopathy
Shortness of breath	May occur in more severe cases of scoliosis (rare)^¶
Past medical history
Previous spine surgeries	Previous laminectomy: Increases risk of spinal deformity Previous fusion: Increases risk of spinal deformity and scoliosis adjacent to the fusion levels
History of hip or knee replacement, infection, or arthritis; hip dysplasia; or lower extremity fracture or amputation	May be associated with leg length discrepancy, which can contribute to spinal deformity
Osteoporosis or degenerative disc disease	Increases the risk for curve progression
Menopause	Associated with progression of scoliosis
History of neurologic condition commonly associated with scoliosis (eg, Chiari II [Arnold-Chiari] malformation, cerebral palsy, Charcot Marie-Tooth syndrome, syringomyelia, spinal cord injury, polio)	Suggests scoliosis secondary to another pathologic condition
History of genetic conditions affecting collagen and bone (eg, Marfan syndrome, Ehlers-Danlos syndrome)	Suggests scoliosis secondary to another pathologic condition
Family history
Family history of scoliosis	Idiopathic scoliosis has a genetic component
Other
What is the patient's quality of life?^Δ Encompasses: Pain with various activities Whether and how long the patient is able to stand and walk Whether the patient is able to perform activities of daily living (eg, getting in and out of bed) Self-image/self-consciousness about posture and appearance	Impaired or worsening quality of life affects management decisions

* Refer to UpToDate content on evaluation of low back pain for additional details.

¶ Refer to UpToDate content on adult scoliosis for additional details.

Δ Quality of life can be more formally assessed with validated tools such as the Scoliosis Research Society-22 or the Owestry Disability Index.*

Graphic 118935 Version 2.0

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Important aspects of the history for adult patients with scoliosis