Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 13 Sept 2026Clinical review pending
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Deformity with neural or respiratory compromise
Rapidly progressive weakness, gait loss, sphincter dysfunction, respiratory compromise, fever or severe night pain with a spinal curve suggests more than uncomplicated idiopathic deformity.
Action: Perform urgent neurological and systemic assessment, protect the spine if instability is possible, and arrange age-appropriate specialist imaging and paediatric or adult spinal referral without waiting for routine curve surveillance.
Synopsis
Recognise spinal deformity across growth stages, use proportionate standing assessment, and refer according to age, progression, neurological risk, respiratory impact and function.
Scoliosis is a three-dimensional deformity, conventionally defined by a standing Cobb angle of at least 10 degrees; posture and leg-length difference can create a non-structural apparent curve.
Age is part of the diagnosis: early-onset disease begins before 10, adolescent idiopathic scoliosis during later growth, and adult deformity may be longstanding or degenerative.
The worked case keeps clinical asymmetry, standing radiographs, growth assessment and the referral outcome visible in Rapid mode.
Key red flags
A new curve with weakness, sensory change, abnormal reflexes, gait disturbance or bladder and bowel symptoms requires urgent neural-axis and spinal assessment.
Scoliosis before age 10, rapid visible progression or worsening during a growth spurt needs prompt paediatric deformity referral because thoracic growth may be affected.
Persistent severe pain, night waking, constitutional symptoms, fever, cancer history or focal bony tenderness suggests infection, tumour or another secondary cause.
Dyspnoea, reduced exercise tolerance or a severe thoracic deformity requires respiratory assessment alongside deformity planning, particularly in early-onset or neuromuscular disease.
Early-onset curve
A structural curve appearing before age 10 needs prompt paediatric spinal-deformity assessment because cause, remaining growth and thoracic development differ; rapid progression, pain, neurological or systemic features make referral urgent.
Neurological deformity
Weakness, sensory change, abnormal reflexes, gait dysfunction or sphincter symptoms with a curve requires urgent cord, root and neural-axis assessment.
Reasoning priorities
01
Standing whole-spine posteroanterior and lateral radiographs
Confirm structural deformity, measure Cobb angle and sagittal alignment, and assess skeletal maturity with proportionate radiation exposure.
Refer after trained clinical suspicion rather than screening radiographs indiscriminately. Interpret curve size with growth remaining and serial progression, not as an isolated treatment command.
Worked reasoning
Worked caseAdolescent rib prominence during growth
A 12-year-old has new shoulder asymmetry and a positive forward-bend test without pain, neurology or systemic illness.
Context: establish age, growth and menarchal or maturity history, family history, progression, pain and neurological symptoms; examine standing balance, leg lengths, skin markers, forward bend and complete neurology.
Reasoning: treat the rotational prominence as suspected structural scoliosis and refer for trained deformity assessment with standing whole-spine PA and lateral radiographs, Cobb measurement and maturity assessment.
Outcome: select observation, brace discussion or operative opinion from curve magnitude, pattern, progression and growth remaining; do not promise that exercise alone will correct a progressive structural curve.
Verification: use consistent low-dose standing technique and serial clinical measurements, monitor growth and function, and escalate if the curve progresses or pain, neurological or respiratory features emerge.
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 13 Sept 2026; clinical approval remains outstanding.
SRS AAOS POSNA AAP adolescent scoliosis screening statementJoint position statement endorsed by SRS, AAOS, POSNA and AAP, published 2015; recommendations and evidence discussion read 13 September 2026. Supports trained adolescent examination at age- and sex-specific preventive visits and minimising unnecessary radiographs; it is a US screening statement, not a UK referral tariff. Chapter-specific use: spinal deformity and scoliosis referral.
Scoliosis Research Society adolescent idiopathic scoliosis guidanceCurrent SRS professional/patient condition body read 13 September 2026: clinical asymmetry, standing radiographs, Cobb measurement, growth-dependent progression risk, and observation, bracing and surgery categories. Applies to adolescent idiopathic scoliosis and does not define congenital, neuromuscular, early-onset or adult treatment. Chapter-specific use: spinal deformity and scoliosis referral.
British Scoliosis Society early-onset scoliosis guidanceCurrent British Scoliosis Society body read 13 September 2026: scoliosis before age 10, heterogeneous idiopathic, congenital, neuromuscular and syndromic causes, growth and thoracic-development implications, investigation and specialist treatment concepts. Professional society patient information, not a numerical national referral guideline. Chapter-specific use: spinal deformity and scoliosis referral.
British Scoliosis Society adult degenerative scoliosis guidanceCurrent British Scoliosis Society body read 13 September 2026: adult deformity symptoms, GP assessment, recognised-centre referral, initial analgesia and physiotherapy, selective injections and surgery after non-operative methods. It does not govern children or acute neurological emergencies. Chapter-specific use: spinal deformity and scoliosis referral.