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September 14, 2008 
The first step in diagnosing the possible presence of scoliosis, or abnormal curvature in the spine, is usually done as part of a child’s routine yearly check-up. In some places, schools have also set up exams through their county medical services or the school nurses’ offices to detect scoliosis early and get the child into observation, and if necessary, into treatment as soon as possible.
At first, the health care provider simply visually examines the child’s spine and body. The spine should be a straight line from the base of the neck to the tailbone. They will also do an Adams test, in which the patient bends forward and the doctor traces the spine with the finger. This allows the doctor manually to detect a curve that may not be visible. Lateral curves—that is, curves that go side to side—are not normal. In addition to the line of the spine, the health care provider will look for differences in the height of each shoulder, in the prominence of the shoulder blades, in the set of the waist and in the height of the hips.
If an abnormality in any of these areas is detected or suspected, the health care provider will then order x-rays to be taken of each of these areas. If the x-rays confirm the presence of a spinal curvature, they will then be used to determine just how curved the spine is. In most cases of scoliosis, the curve is very slight and will not need treatment at all. However, x-rays will be a part of the patient’s future, as the condition is monitored throughout childhood, until the patient is fully grown.
When diagnosing the severity of the scoliosis and the possibilities for treatment, the age of the patient is one major consideration. The younger the patient, the more options there are for non-invasive treatments, or for simply observing. The older and taller an adolescent gets, the more serious their scoliosis can become, and if it is not diagnosed until later is adolescence, it may be more difficult to treat.
Another important point for diagnosis is the severity of the curve, which is determined by the visual, manual, and x-ray exams. Spinal curves are usually divided into three categories: under 25 degrees of curvature, 25 to 40 degrees of curvature, and over 40 degrees of curvature. These divisions will help the doctors decide what course of treatment will be best for the patient, but the guideline is that under 25 degrees will require no treatment but will require observation, 25 to 40 degrees will usually be treated by wearing a brace and doing the accompanying exercises, and over 40 degrees will usually result in surgery.
Further diagnostic work will depend on what is seen in the x-rays. Several different factors will contribute to a diagnosis, including shape of the curve, location—or where in the spine it occurs, direction, angle—or how sharp the curve is, and cause—whether it is an unknown cause or a symptom of another disease.
