Diagnosing Scoliosis & Kyphosis

Every person’s spine has some natural curvature. These curves help the spine to support the weight of your head and body. They also ensure balance and stability while your limbs are in motion. If these natural curves change or become unusually pronounced, the resulting imbalance can compromise the function of the spine and make moving more difficult or painful. 

At NYU Langone, spine specialists in orthopaedics, neurosurgery, neurology, and radiology work together when diagnosing a spinal deformity in adults to ensure that your spine and the surrounding nerves and muscles are evaluated as an interconnected system. Our experts use new imaging techniques to identify a pronounced curve and to determine whether the spine is unstable or affecting nearby nerves or organs.

Multiple factors can lead to a diagnosis of adult scoliosis or kyphosis in someone who had a normal spine growing up. These include degenerative disc disease, which is caused by a gradual breakdown of the cushion-like discs in between the bones of the spine, called vertebra; osteoporosis, a condition that causes weakened bones; and neuromuscular disorders, such as Parkinson’s disease, which can interfere with how signals travel between muscles and nerves and lead to changes in the shape of the spine. 

Some people may have a genetic tendency toward scoliosis or kyphosis. In other instances, no particular cause for the condition can be found. 

Scoliosis

Scoliosis occurs when the spine curves sideways into a shape that may look like an “S” or “C” when viewed from behind. Some adults with scoliosis may have been told during childhood that they had the condition but never experienced pain or dysfunction. Other adults develop scoliosis later in life, as the spine begins to wear down with age. Rarely, adults develop scoliosis as the result of a spinal injury, due to, for instance, a car crash or serious fall. 

The degree of curvature varies among people with scoliosis, and some people don’t experience any visible symptoms. Doctors sometimes accidentally discover that a person has an unusual curvature during the diagnosis and treatment of another condition. For example, a chest X-ray can reveal an unexpected spinal curve. 

Some people notice physical changes in posture—for example, a loss of height may indicate that the spine is changing shape—or feel an aching pain in the back or neck during physical activity. If you feel a radiating pain in the arms or legs, or a tingling or numb feeling in the hands or feet, this may be a sign that a bone in the spine is pinching a nearby nerve. A pinched nerve is not always a symptom of scoliosis or kyphosis, but any change in the alignment of the spine may increase the risk of a pinched nerve.

If scoliosis progresses to the point that it’s causing a very significant curvature, this can lead the spine and the ribcage to put added pressure on the heart or lungs, causing damage. Diagnostic imaging at NYU Langone can confirm the degree of curvature due to scoliosis and indicate if nerves or organs are affected.

Kyphosis

Kyphosis is a condition in which there is too much forward curve in the spine, causing a bowed or rounded posture. Some kyphosis in the middle part of the spine is normal, but a pronounced forward curve can result in stiffness and pain in the back and an overall sense of fatigue. The term “hyperkyphosis” is sometimes used to describe this exaggerated curvature. 

Kyphosis is most common in the middle part of the spine, also called the thoracic spine. However, it can affect any part of the spine. In adults, kyphosis is usually caused by age-related degeneration of the spine. In particular, spine compression fractures, which occur when the front part of a vertebra breaks and collapses, may lead to kyphosis.

Mild kyphosis may not cause any symptoms or signs except poor posture. However, the degree of curvature can progress over time, and more severe symptoms may develop, including radiating pain, tingling or weakness in the arms and legs, and difficulty breathing. Very severe thoracic kyphosis may restrict the ribcage and cause heart and lung problems.

Diagnostic Exams and Tests 

When assessing the degree of curvature of the spine to confirm a diagnosis of scoliosis or kyphosis and the potential impact on your overall health, NYU Langone doctors ask questions about your medical history and conduct a physical exam. If necessary, they may recommend one or more diagnostic imaging tests.

Medical History

As part of the diagnosis process, our doctors ask a variety of questions. They may ask when you first noticed pain or other symptoms, whether these symptoms affect you constantly or only during certain times of the day or during certain activities, whether symptoms affect your day-to-day lifestyle, and if any of your family members have been diagnosed with scoliosis, kyphosis, or other medical conditions affecting the spine. 

In addition, our doctors may ask for details about any current medications you take or if you’ve had a spine injury or surgery in the past. These and other details help the doctors to confirm a diagnosis of scoliosis or kyphosis.

Physical Exam

Your doctors may ask you to walk or to move your body into different positions, so that they can obtain a sense of how well your spine moves and whether any specific movements cause pain. They can also visually identify the degree of curvature during a physical exam, typically by asking you to bend forward. This initial physical assessment can be compared with subsequent measurements, allowing our doctors to detect any changes in the spine’s curvature.

X-rays and EOS Imaging 

X-rays use high-energy beams of light to provide doctors with images of your spine that can indicate an abnormal curvature. EOS® imaging, a newer technique, is a type of X-ray used to obtain three-dimensional pictures of the entire body, including all parts of the spine and any soft tissue that may be affected by the spine. 

EOS® imaging uses one-tenth of the amount of radiation of a standard X-ray. This procedure requires that you stand upright and takes 30 seconds to complete. NYU Langone is one of the first medical centers in New York City and the country to use this technology. 

MRI Scans

MRI uses magnetic fields and radio waves to create detailed two- and three-dimensional images of the spinal cord, nerves, and surrounding soft tissue. If you experience radiating pain in the arms or legs, or feel any weakness or tingling, an MRI scan can reveal whether this pain is the result of a pinched nerve near the spine.

CT Scans

CT scans use X-rays to create a series of two- and three-dimensional images of the bones of the spine from a variety of angles. The images are combined by a computer to provide specialists with detailed visual information about any curvature in the spine. 

CT-Myelography 

On rare occasions, when doctors need more details about the anatomy of the spine than a traditional CT scan can provide, CT-myelography may be recommended. In this procedure, doctors inject a water-based dye into the fluid surrounding the spinal cord. This dye highlights the nerves and spinal cord, making them easier to see on the resulting CT images.

Bone Density Test

During this simple test, a series of X-rays, usually of your lower spine and hips, are taken in order to determine the amount of calcium and other minerals present in your bones. It's important for your doctor to identify if you have low bone density, because the presence of weakened bones may affect treatment options for scoliosis. Mild loss of bone density is called osteopenia, and more severe loss of bone density is called osteoporosis. If spinal surgery for scoliosis is necessary, osteopenia or osteoporosis can sometimes be treated prior to surgery to maximize the chance of successful healing.

Doctors recommend that women, in particular those older than age 60, have a bone density test annually to screen for osteopenia or osteoporosis.

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