1. Medical history (1) Onset: Scoliosis as a clinical symptom is first detected unintentionally by parents or teachers as a backward projection of one scapula and unequal height of both shoulders, and for AIS, the first detection is usually at the age of 10 to 13. (2) Clinical symptoms: Initially diagnosed scoliosis has back deformity as the main symptom, especially asymmetrical posture when standing, such as unequal height of both shoulders, backward projection of one scapula, and asymmetrical anterior chest. However, severe scoliosis can lead to thoracic rotational deformity, upper body tilt, thoracic sagging, trunk shortening and decreased activity endurance due to decreased thoracic volume, shortness of breath, palpitations, etc. A few patients may experience low back pain. In some patients, scoliosis is discovered unintentionally and the clinical deformity may not be obvious. (3) Family history: Although the relationship between AIS and heredity is not yet clear, clinical observation shows that AIS has a certain genetic tendency. It is important to know the usual health status, intelligence level, and maternal history of pregnancy and childbirth to exclude non-idiopathic scoliosis. For example, knowledge of the patient’s birth history and history of poliomyelitis can help distinguish between cerebral palsy caused by a difficult birth and scoliosis after poliomyelitis. It is also important to know the age of onset of scoliosis and the progression of the disease. Idiopathic scoliosis mostly develops during adolescent development and progresses rapidly during the rapid growth phase. Neuromyogenic scoliosis can develop at any age and continues to progress after growth has ceased, whereas AIS does not worsen significantly once spinal growth has ceased. In addition, the girl’s menstrual status is essential to assess the progression of scoliosis and to guide treatment. 2. Physical examination Because idiopathic scoliosis is a diagnosis of exclusion, a detailed clinical examination must be performed to rule out other causes of scoliosis. (1) General condition: The patient’s upper body is fully exposed and only shorts are worn to observe the patient’s health status, speech, secondary sexual characteristics, gait, skin condition, and the presence of joint laxity and stiffness. the general condition of the patient with AIS is normal except for the height, which is slightly higher than that of his peers. (2) Torso: The shoulders were measured in the standing position to see if they were level, and the distance from the hip crack to the trans-C7 dip. Observe whether the thoracic spine has a reduction in physiological lordosis or anterior lordosis. When the patient is allowed to perform forward flexion, the rotational deformity of the thorax and the unequal height of the scapulae, commonly known as razorback deformity, can be clearly demonstrated. (3) Neurological system: Pay special attention to the presence of pigmented lesions, subcutaneous masses, lipomas, hemangiomas, nevi, localized skin depressions and hair along the midline skin area of the back, which are signs that strongly suggest the presence of developmental malformations of the spinal cord. Careful examination of the abdominal wall reflexes and both lower extremities for muscle strength, sensation and possible pathological reflexes or localized muscle paralysis. X-rays are the primary means of diagnosing scoliosis and can determine the type, etiology, location, severity and tenderness of the deformity. Radiographs should be taken in the standing position with the full-length frontal and lateral views of the spine, including the iliac crest on both sides, to reflect the true condition of the deformity and the balance of the trunk. (1) Curvature measurement: First, the upper and lower vertebrae of scoliosis are identified on the orthopantomograph, which are the two most inclined vertebrae in the entire curvature, usually in a rotational neutral position, and a straight line is drawn along the upper endplate of the upper vertebrae and the lower endplate of the lower vertebrae, and the angle of intersection of the two lines is the Cobb’s angle of scoliosis. In the same way, possible abnormal sagittal patterns, such as anterior or excessive retroversion of the thoracic spine, are measured on the lateral radiographs. (2) Measurement of vertebral body rotation: according to the position of the vertebral arch in relation to the lateral wall of the vertebral body on the orthogonal radiograph, it is divided into 5 degrees: 0 degree for symmetry of the vertebral arch; Ⅰ degree for the convex side of the vertebral arch moving to the midline but not beyond the first frame, and the concave side of the vertebral arch becoming smaller; Ⅱ degree for the convex side of the vertebral arch having moved to the second frame, and the concave side of the vertebral arch disappearing; Ⅲ degree for the convex side of the vertebral arch moving to the center, and the concave side of the vertebral arch disappearing; Ⅳ degree for the convex side of the vertebral arch (3) Estimation of skeletal development (3) Estimation of skeletal development: Skeletal maturity is important in assessing the progression of scoliosis and deciding on treatment measures, and is often estimated by the iliac epiphysis, or Risser’s sign. The iliac crest can be divided into 4 equal parts, with the epiphysis moving from the anterior superior iliac crest to the posterior superior iliac crest. 25% movement of the epiphysis is degree I, 50% is degree II, 75% is degree III, movement to the posterior superior iliac crest is degree IV, and fusion of the epiphysis with the iliac bone is degree V. At this point, skeletal development ceases, and the fusion of the epiphyseal ring of the vertebral body with the vertebral body on the lateral radiograph also indicates cessation of spinal growth and development.