Double thoracic curves often present as unequal shoulders caused by the high left thoracic curve. Finally, lumbar curves present with an asymmetric waistline and unequal arm-to flank distances. A careful neurologic examination should be performed in every child who has scoliosis. A baseline radiograph is necessary in almost all cases of scoliosis because one cannot differentiate idiopathic from congenital scoliosis by clinical examination alone. Congenital scoliosis has a much different prognosis and is associated with renal, heart, and intraspinal anomalies that may be important to detect early.
Radiographs remain the standard for documentation of scoliosis.
Topographical methods for evaluating trunk rotation such as the inclinometer, the Moir Fringe Evaluation and the ISIS system have not been proven to be accurate or definitive indicators of scoliosis. In growing children, curves of less than 25 degrees can be safely followed since many will not worsen or require treatment. However, curves in the magnitude of 25 to 30 degrees or greater, often require active treatment at the time of diagnosis. It is suggested that growing children with curves of less than 10 degrees be followed annually. They often do not need x-rays at every outpatient visit.