Scoliotic Attitude

If we see our child with “crooked” back, is it scoliosis? The answer is that it is not necessarily a scoliosis. When it is not a scoliosis we call it “scoliotic attitude”. The prognosis and treatment is completely different, so it is important to know how to differentiate them. I will tell you the difference although it is important to always receive the follow up of a specialist who gives us the proper diagnosis.

A child can walk with his back twisted for many reasons. Scoliosis is a structural cause, that is, your spine is actually “twisted.” Having a deformity in the shape of the spine will see abnormal asymmetries and postures that the child cannot avoid because his spine is so. There are other situations that may make our posture resemble that of a deformity such as scoliosis but without it.

Scoliotic AttitudeHow do we differentiate a scoliosis from a scoliotic attitude?

The key in most cases is the complete column radiograph. Scoliosis has a number of features on the x-ray that make it unequivocal. The vertebrae not only draw a deformity in the form of a curve, but also that the vertebrae are rotated.

Scoliotic attitudeLet’s look at this first photo. Do you think it is a scoliosis? The answer is that it is not a true scoliosis, it would be a scoliotic attitude. How do we know? Let’s see him seeing a real scoliosis first.

Let’s look now at the image of the X-ray below. It is a scoliosis that draws a double curve and in which there is rotation of the vertebrae. An x-ray offers a two-dimensional image and rotation is a three-dimensional concept. The rotation can be measured by seeing where the spinous process is located with respect to the rest of the vertebra. The spinous process is the part of the vertebra that protrudes and that we notice when touching the back to us. This process is in the middle part of the vertebra and I painted it in red so that we understand it. The spinous process should be in the center of the vertebra. If we see the edges of the vertebra that I have painted in blue we see that it is not so. In the image we see how the spinous processes are not in the center, they are near the edge of the right.


Let’s go back to the previous image of the gentleman with the back “crooked”. If we look at this column, the spinous processes are all in the midline of the vertebra, that is, there is no rotation. It is not a scoliosis.

Keep in mind that I am talking about an idiopathic scoliosis that is the most common. Sometimes there are other signs more evident such as congenital defects in some vertebrae that cause scoliosis.

We have talked about the X-ray but you can also see the difference in physical examination. The rotation of the vertebrae produces asymmetries in the back. The most obvious is that one side protrudes more than another, especially in the dorsal area where the ribs are. We form what we call gossip. If you look at the initial photo of the post we can see that there are neither asymmetries nor one side stands out more than another. It is also a scoliotic attitude.

What do we do with a scoliotic attitude?

If we see that the person has a scoliotic attitude we must try to find out why. It can be from a postural problem, to a physical reason such as a shortened leg or a psychological problem. Sometimes a painful illness or injury can make us adopt “twisted” postures for pain. It is important to evaluate all these situations and solve the problem that is causing this position.

In general, if there is no significant problem following this scoliotic attitude, the prognosis is very good and does not have the same repercussions as true scoliosis. Many times it does not require any treatment and with the passage of time and the development of the musculature the situation will be corrected by itself. Proper evaluation by a specialist in scoliosis and proper follow-up is recommended until the problem is solved.

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