In for the head to be positionedIn for the head to be positioned

In medicine, one of the most powerful tools to empathize with a patient is sharing an anecdote. In a term coined by Aristotle, the three artistic proofs, the use of anecdotes with patients gives the provider a level gravitas and relatability rarely established outside of its use. In fact, by supplying a story of one’s own endeavours, either medical or related to the field, the professional can establish a sense of ethos and pathos that can make interacting with a patient easier and more fulfilling. This ability to easily interact with individuals can be important, especially when dealing with obstinate or young patients. One example would be when dealing with individuals affected by scoliosis. According to the American Association of Neurological Surgeons (AANS) about 2-3% of the American population (~ six to nine million individuals) suffer from Scoliosis. A majority of these  individuals show onset symptoms between the ages of 10-15 years (Scoliosis, 2016). To this extent, my history with scoliosis provides me with critical insight in how one suffering from the illness may react to different treatment possibilities as well as the different treatment possibilities. Scoliosis is defined as an having an abnormal curvature of the spine, predominantly in a lateral fashion (Scoliosis, 2016; Van Goethem, et. al., 2007). The normal curvature of a spine is when the curves are in the lumbar, thoracic, and cervical regions, dubbed the “sagittal” plane. This curvature allows for the head to be positioned over the pelvis and thus the spine effectively acts as “shock absorbers” for the stress of walking. In individuals that suffer from scoliosis, the curves aren’t in the “sagittal” plane (which is anatomically splitting an individual from left to right) but rather in the “coronal” plane (splitting an individual vertically that divides them into ventral and dorsal regions) (Oestrich, et. al., 1998; Kim, et. al., 2010; Idiopathic scoliosis imagine, 2017) . This can lead to, depending on the severity: uneven shoulders, off-center head so that it is not aligned with the pelvis, raised hips, uneven waist, and rib cages at different heights (Weinstein, et. al., 2008). If left unchecked, these symptoms can affect the patient’s ability to walk, move, and breathe. Coincidentally, even though in the United States scoliosis affects males and females about equally, according to the AANS, “females are eight times more likely to progress to a curve magnitude that requires treatment” (Scoliosis, 2016). There are three etiologies of scoliosis: congenital, neuromuscular, and idiopathic (Scoliosis, 2016; Van Goethem, et. al., 2007; Wang, et. al., 2015). The most common form of scoliosis is idiopathic, mainly adolescent idiopathic scoliosis, and encompases about 80 percent of all cases of scoliosis (Weinstein, et. al., 2008; Scoliosis, 2016). Idiopathic scoliosis is diagnosed in infancy or early puberty and is thought to have a genetic component since having a close relative with scoliosis increases prevalence (Weinstein, et. al., 2008). In my case, I was diagnosed with idiopathic scoliosis at the age of 14, and I knew it was most likely hereditary because my uncle on my mother’s side was affected by the condition. Neuromuscular is when scoliosis is associated with neurological or muscular diseases such as: cerebral palsy, muscular dystrophy, and spina bifida. It is important to note that this is the most aggressive form of scoliosis and requires surgery more often than either of the other forms. Lastly, congenital scoliosis is a result of malformations of the vertebra at the the embryonic stage. For the most part, doctors are able to detect these irregularities extremely early on since it’s present at birth and treatments are easier to determine since the location and severity of the abnormality informs the magnitude of scoliosis (Scoliosis, 2016).   When diagnosing scoliosis, there are approximately five different ways to do so and they can be used in tandem or individually: spinal radiographs, MRIs, CT scans, x-rays, and physical examinations (Idiopathic scoliosis imaging, 2017; Scoliosis, 2016). For adults, severity of curve is usually measured using the Cobb method in which  a posterior-anterior radiograph is used to measure the coronal curvature. This is done using a scoliometer that is placed at the apex of the spinous process to measure the angle of trunk rotation (Scoliosis, 2016). Values of ten degrees or greater is considered positive diagnosis for scoliosis. Significant scoliosis values are between twenty five and thirty degrees or greater and severe scoliosis is caused by curves exceeding forty five to fifty degrees and often require aggressive treatment (Idiopathic scoliosis imagine, 2017; Kim, et. al., 2010). In individuals that are in grade school, such as when I was diagnosed, the Adam’s Forward Bend Test can be used. The examiner will ask the individual to bend ninety degrees at the waist and any abnormal curvature or asymmetrical morphology can be easily seen. This often acts as a screening test and then must be followed up with radiographic tests that provide an accurate diagnosis and assessment of severity. It’s also important to note that depending on the age at which an individual is diagnosed with scoliosis alters the veracity in which it is treated. This is because scoliotic curves do not often progress after the end of growth (Idiopathic scoliosis imaging, 2017).  Therefore radiography is extremely critical for the diagnosis and measuring of progress in scoliosis. Radiography can confirm the putative diagnosis and monitor progression (as listed above), can make sure that there’s no other underlying causes for the curvature- like a tumor-, severity of curvature, and even assess the patient’s need to have surgery (Idiopathic scoliosis imaging, 2017; Kim, et. al., 2010). The three most used tests are: x-rays, which are shot in long-spine plain films in the AP and lateral projections, show vertebrae structure and joint outline (Idiopathic scoliosis imaging, 2017), CT scans, which assess the shape and size of the spinal canal and surrounding bony structures, are critically important because they can render 3D images which is important since scoliosis is a 3D rotational abnormality (Sangole, et. al., 2009), and MRIs that observe nerve roots, the spinal cord, and can assess deformities or degeneration occurring in the spinal column (Hesarikia, et. al., 2015; Wang, et. al., 2015). Usually, when surveying scoliosis, a posteroanterior radiograph while the individual is upright is used, but if the patient is being clinically treated the radiographer may include lateral vertical beam images, and right and left lateral bending images, as recommended by the American College of Radiology. The purpose of this is to identify the apex of the curvature, which indicates the severity of the scoliosis, and includes where it’s located and the direction of the curve and this can inform what kinds of treatments might be best for the patient.  Once an individual has been diagnosed with scoliosis and then the severity of the curvature has been determined, the last step is treatment. Ultimately there are currently three treatments available to individuals: observation, a brace, and surgery. Which treatment is used depends predominantly on the information derived from the radiographs (Idiopathic scoliosis imaging, 2017; Kim, et. al., 2010). In preoperative individuals, the use of x-ray monitoring is the most abundant because it can effectively see the rotations of vertebrae and severity of the curve while unobtrusively observing progression. X-ray is also the fastest method of detection and progression observance, so in cases that have been cleared of infection, tumor, and other degenerative diseases this proves to be the most effective radiography method (Van Goethem, et. al., 2007). In individuals that have surgery, CT scans and MRIs are much more necessary (Barwick, et. al., 2009). Due to the ability of CT scans to render 3D images, it makes it critical for assessing any post-operational abnormalities and using coronal and sagittal reconstructions the radiologist can assess abnormalities in segmentation as well as morphological abnormalities (Oestrich, et. al., 1998). MRIs are critical because of their ability to assess nerve damage, which often occurs in curves that exceed fifty degrees, as well as spinal lesions and any infections that might occur post operations (Barwick, et. al., 2009; Hesarikia, et. al., 2015; Wang, et. al., 2015).Ultimately radiography is the only way to monitor the progress of scoliosis and also the only way to get a definity prognosis. In the absence of radiography, secondary reasons for abnormal spinal curvature such as tumors, abnormalities in vertebral segmentation, malformation in the spinal column, and infections might never been seen and simply tossed into a scoliosis “catch-all” term. It is the ability to see not only the spine but the surrounding structures and tissues, that make radiography so invaluable to the detection and diagnosis of scoliosis. This is a topic that is extremely important to me because not only was I diagnosed with scoliosis but I underwent the surgery. The ability for health care providers to accurately see and assess my condition lead to effective treatment that restored complete mobility and my ability to sleep comfortably. Without radiology, effective treatment would be impossible and individuals would have to suffer through a condition that can get progressively worse to such a state that it inhibits the ability to move.