X-ray of scoliosis

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Author: Mikael Häggström [notes 1]

X-ray of scoliosis - crop.jpg


Choice of modality

X-ray of scoliosis is generally the choice for both initial evaluation and follow-up.


Moderate thoracic levoscoliosis with a Cobb angle of 40° between Th6 and L1, and a mild lumbar dextroscoliosis of 17° between L2 and L5.
  • Categorization into dextroscoliosis (convex towards the patient's right) or levoscoliosis (towards left). Typically, there is a main curvature, with secondary counter-curvatures above and below it, which should be measured as well in more severe scoliosis, or if it is not clear what is the main curvature.
  • Cobb angle measurement of the anticipated greatest angle seen. angle formed between a line drawn parallel to the superior endplate of one vertebra above the fracture and a line drawn parallel to the inferior endplate of the vertebra one level below the fracture.
  • Severity grading of the Cobb angle:
Scoliosis severity Cobb angle
Not scoliosis <10°[1]
Mild 10 - 30°[2]
Moderate 30 - 45°[2]
Severe >45°

Optionally: Coronal balance, which is the horizontal distance between the middle of the vertebral body of C7 and the midline of the sacrum. It is significant if measuring over 2 cm.[3]


  • Dextro- and/or levoscoliosis, or "mild dextro-/levoconvexity but no scoliosis"
  • Cobb angle in numbers, and between which levels, if the referral has any focus on the scoliosis, otherwise a severity grading is enough.

If measured: Significant coronal imbalance

See also: General notes on reporting


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.


  1. Page 89 in: Dr. Kevin Lau. The Complete Scoliosis Surgery Handbook for Patients: An In-Depth and Unbiased Look Into What to Expect Before and During Scoliosis Surgery . Health In Your Hands. ISBN 9789810785925. 
  2. 2.0 2.1 Page 460 in: Konrad E. Bloch, Thomas Brack, Anita K. Simonds (2015). ERS Handbook: Self-Assessment in Respiratory Medicine . European Respiratory Society. ISBN 9781849840781. 
  3. Yuranga Weerakkody and A.Prof Frank Gaillard. Coronal balance. Radiopaedia. Retrieved on 2019-01-16.