The Problem with Scoliosis X-Rays

Have you ever had a concern about over-exposure to X-rays in your child or teen with scoliosis?  This concern is a valid one, as studies have shown an increased risk of cancer from X-ray exposures taken for scoliosis 1,2.  Various efforts have been made to address the risk of over-exposure to radiation; the most immediate of “solutions” has been this:  Take fewer X-rays.3

While taking fewer X-rays sounds great, this also presents a problem.  Without X-rays how are we to know the condition of one’s scoliosis?  During adolescent growth, the scoliosis Cobb angle can increase in size rapidly in just a few months (Cobb angle is the official measure of a scoliosis curve severity).

Taking fewer X-rays means the sudden worsening of mild scoliosis can be missed, which leads to a greater probability of developing severe scoliosis requiring surgery.

In recent decades X-ray technology has improved and new X-ray machines, such as the EOS, can significantly reduce radiation exposure. Precautions can also be taken such as turning down the exposure and covering the child’s organs with lead shields, however, the major flaw of all strategies that “minimize” radiation is that they still use harmful radiation, and therefore they must all be used as little as possible.4

This brings us back to the same problem:  We need to be able to watch the spine very closely during growth but need to avoid the frequency of radiation exposure.  As a result, doctors space the imaging out too far apart, taking scoliosis X-rays every 6 months or one year.

 

References

  1.  Simony A, Hansen EJ, Christensen SB, Carreon LY, Andersen MO. Incidence of cancer in adolescent idiopathic scoliosis patients treated 25 years previously. Eur Spine J 2016;25:3366–70.
  2. Hoffman DA, Lonstein JE, Morin MM, Visscher W, Harris BS, Boice JD. Breast cancer in women with scoliosis exposed to multiple diagnostic x rays. J Natl Cancer Inst 1989;81:1307–12.
  3. Knott P, Pappo E, Cameron M, et al. SOSORT 2012 consensus paper: reducing x-ray exposure in pediatric patients with scoliosis. Scoliosis 2014;9:4.
  4. Ng S-Y, Bettany-Saltikov J. Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis. Open Orthop J 2017;11:1500–20.