Scoliosis of the Spine Initial Diagnosis

Scoliosis of the Spine Initial Diagnosis

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Diagnosing scoliosis starts with a posture evaluation.

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Scoliosis, or abnormal curvature of the spine, may be diagnosed at any age. It is often first suspected by an observant parent, friend or teacher of a growing child. A more formal evaluation of posture can help with a diagnosis. A doctor may order x-rays to determine the nature and severity of the spinal curvature. X-rays also help determine what, if any, treatment may be necessary. Treatment may include "watchful waiting," exercise therapy and bracing. Surgery is sometimes recommended for severe cases of scoliosis.

Postural Screening

Some school districts conduct scoliosis screening. This is often done in middle school, when students are in a phase of rapid growth and at increased risk of developing scoliosis. California has developed guidelines for scoliosis screening using visual inspection. This assessment can also be done at home.

With the back exposed, look for: tilting of the head; uneven shoulders; asymmetrical protrusion of a shoulder blades; hips that are not level; arms that do not hang evenly from the body; excessive shoulder rounding; or swaying of the lower back. Next, have the child place her chin to her chest, clasp her hands together in front of herself and bend forward 90 degrees at the waist. Look for excessive rounding of the back. Check to see if one side of the back is higher than the other or a hump appears on one side of the rib cage. If the postural screen raises concerns, follow up with your health care provider.


According to the text "Essentials of Skeletal Radiology," an x-ray is the most important diagnostic test for evaluating scoliosis. X-rays are helpful in determining the cause of the scoliosis, assessing bone maturity to judge the likelihood of curve progression, and evaluating the site, magnitude and flexibility of the spinal curvature. X-rays are also used to determine appropriate treatment and monitor scoliosis progression or regression.

Scoliometer Measurements

People with significant scoliosis typically exhibit unevenness of the rib cage when bending forward at the waist. One side of the rib cage typically appears raised -- a feature commonly called a "rib hump" -- and the other side is lower. This asymmetry is caused by rotation of the rib cage due to abnormal curvature of the spine.

A scoliometer is an instrument used evaluate scoliosis. This simple tool indirectly assesses scoliosis by measuring the side-to-side slope of the rib cage in the forward bend posture. Although this device may provide helpful information, a study published in February 1990 in the journal "Physical Therapy" concluded that the scoliometer contributes little to the initial diagnosis of scoliosis.


The degree of spinal curvature at initial diagnosis and how much spinal growth remains to attain full adult height affects treatment recommendations for scoliosis. Mild curvatures in adolescents who have nearly mature spines may not require treatment. Mild to moderate curvatures in children with less mature spines often warrant x-ray monitoring every 6 months to detect signs of scoliosis progression. Bracing may be recommended if there is evidence of scoliosis progression or the child is at high risk for worsening of the condition. Surgery to straighten the spine may be recommended for severe scoliosis. Exercise may not prevent worsening of scoliosis but is recommended to maintain spinal strength and flexibility for anyone with the condition.


Fewer than 1 in 10 adolescents diagnosed with scoliosis experience progression of the condition requiring medical treatment, according to the authors of a 1999 review published in the journal "Orthopedic Clinics of North America." Certain variables at the initial diagnosis help predict the likelihood of scoliosis progression. In September 1984, the "Journal of Bone and Joint Surgery" published a study that followed more than 700 individuals with untreated scoliosis. It identified 3 factors most commonly associated with increased risk of curve progression. The larger the curve at initial diagnosis, the younger the patient when the curve was detected and x-ray signs of skeletal immaturity were associated with an increased risk of worsening scoliosis.