The appearance of a high side and a low side in the back can have pathological and physiological factors. Some people who are engaged in fitness exercise, on the dominant hand side, the latissimus dorsi or trapezius muscle appears to be particularly developed, and they will show high shoulders, while the weaker side will appear low, which is easily observed in patients who work a lot. Pathological conditions, especially seen in children and adolescents, presenting with unequal height of both shoulders cooked called razorback deformity, require a high degree of suspicion of scoliosis. Scoliosis presents with a change in the level of height of the ribs on both sides, which can be assisted by positive and lateral radiographs of the thorax and lumbar spine. In patients with scoliosis, a comprehensive assessment of the severity is needed, and some can be corrected in time with thoracolumbar braces, while others may require surgical treatment.