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.
Many experienced physicians follow mild scoliosis by physical examination only.
Other than periodic observation and documentation, the only two effective methods of managing scoliosis are orthotic treatment and surgery. Occasionally, patients are seen whose curves have no doubt worsened substantially while ineffective treatments have been applied. A growing child with a curve in the range of 25 to 30 degrees up to 40 degrees should be treated with an appropriate orthosis. Radiographs of the hand and wrist may be compared to a standard atlas to further confirm skeletal maturity. It is very important for the patient, the parents, and the physician, to realize that the goal of orthotic treatment of idiopathic scoliosis is simply to halt curve progression.