The evaluation begins with a thorough history as is the dictum in medical evaluation procedures and it is followed by complete physical examination and neurological examination. This is followed by radiographic evaluation
In physical examination, after the general physical examination, the spine is examined and characteristics of the deformity are recorded.
The height of the patient while standing and while sitting should be measured and recorded. These measurements can be compared with future measurements in follow up to determine changes in the patient’s total height and whether any change is caused by growth of the lower extremities or by an increase or a decrease in the height of the trunk.
A detailed physical and neurological examination would help to rule out any neoplasm or a neurological disorder as the cause of scoliosis.
Posteroanterior and lateral radiographs of the spine with patient in standing position are made and should also include iliac crest iliac crest distally and most of the cervical spine proximally. The use of posteroanterior view in comparison to anteroposterior view lessens the radiation dose to maturing breasts which sustain the most at risk from radiation
If patient is being considered for surgery a right and left bending films usually are obtained.
Due to vertebral rotation in scoliosis, standard anteroposterior views of scoliosis curves significantly underestimate the magnitude of the curve and also give the erroneous impression of kyphosis. Stagnara radiographic technique eliminate this rotational component of the curve , allowing a much more accurate measurement of the curve size and better evaluation of vertebral anatomy.
In this technique, an oblique radiograph is made with the cassette parallel to the medial aspect of the rotational rib prominence and the x-ray beam positioned at right angles to the cassette. This provides modified posteroanterior view. A film made at 90 degrees to this provides the true lateral view.
For assessing the skeletal maturity, the most common is assessment of bone age at the hand and wrist or Risser sign.
MRI of the whole spine is required for assessment if there is an unusual curve, a very rapid prgession and a very large curve at presentation.