Physicians use the plane and the position of a curve relative to the spine to describe curvatures of the back. The term scoliosis implies lateral spinal curvature in the coronal plane and necessarily involves a rotational component as well. The rotational component is visualized most often as a rib hump viewed posteriorly when the spine is flexed. Scoliosis is described by the severity and position of the rib hump and can be measured in various ways. Kyphosis is an exaggerated curve of the thoracic spine in the sagittal plane with the apex of the curve directed posteriorly. Lordosis refers to a marked curvature that occurs in the sagittal plane of the lumbar spine with the apex of the curve directed anteriorly. Curvature of the spine can present with varying severity and may progress with age and growth. Beyond skeletal maturity, scoliosis generally does not progress; however, kyphosis and lordosis may progress into adulthood.

• Family history of scoliosis is present in approximately 30% of new cases of scoliosis.

• Sports participation and day-to-day functioning usually are not affected by the curvature of scoliosis.

• Complaints of back pain are not characteristic of idiopathic scoliosis and should prompt the physician to rule out other diseases.

• Progressive scoliosis is more likely in nonambulatory patients than ambulatory patients.

• The curvature of idiopathic scoliosis is more likely to progress during times of rapid growth.

• Rapidly progressing curves are more likely to require treatment.

• Kyphosis can be postural or structural in nature.

• Postural kyphosis is generally flexible and corrected with adjustment of posture.

• Fixed kyphosis may cause pain with neck motion.

• Radicular pain, changes in bowel or bladder function, sensory abnormalities, and problems with balance and/or coordination all point to an underlying neurologic problem.

• Constitutional symptoms—including prolonged fever, weight loss, night sweats, and malaise—may provide clues regarding malignancies or inflammatory diseases.

• Bony deformities detected upon palpation along the spine suggest vertebral anomalies or spinal dysraphism.

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