Physical Signs: Patients with adolescent idiopathic crural scoliosis have a number of distinctive physical signs. Depending on the shape and size of the scoliosis, crestal scoliosis may be barely visible or there may be obvious physical signs. The most common is an asymmetry in shoulder height, where one shoulder is higher than the other. Side-to-side body shifts can also occur, especially if the body has only one bend in the chest or waist and not the other to balance the patient. This is commonly seen in lumbar asymmetry, which is characterized by one hip being higher than the other, and which causes one leg to appear longer than the other. A protruding back or bulging ribs are obvious signs for rotational crural scoliosis. When viewed from the side, patients with adolescent idiopathic crural scoliosis are normal. In addition, there are usually no neurologic abnormalities, such as decreased or abnormal superior sensation or the presence of short limbs. Imaging studies Typical images that can determine the presence of crural scoliosis include full crural radiographs in the standing position, both dorsal (AP radiographs) and lateral (lateral radiographs). Lateral line films are used to determine crestal lordosis in the chest (hunchback) and crestal lordosis in the lower back (concave back). After the films are taken, your doctor will measure the line film using the Cobb method to determine the size of your crestal scoliosis. However, it is important to note that the position in which the patient is standing during the x-ray and a number of other factors can also contribute to a slight scoliosis. There are also photographs to be taken to assess flexion flexibility at the time of surgery, known as evaluation films. These include the supine maximal voluntary lateral flexion film, which is taken with the patient in as much lateral flexion as possible; the traction line film, which is taken with the patient stretching the crestal column apart with the arms and legs; and a pivot-flexion image, which is taken when a rolled shape is filled in at the set point of the scoliosis to correct the flexion. These images are often taken during surgical treatment. When brace treatment is performed, the images clearly show the brace, ensuring that the brace is effective in achieving correction of the scoliosis. When bracing is used to correct scoliosis, x-rays are often used to determine the progression of the condition. x-rays can be taken during or after bracing surgery, depending on the surgeon’s preference. Magnetic resonance imaging (MRI) is not commonly used in the examination of adolescent idiopathic crestal scoliosis. It is used exclusively to re-examine things other than the crestal column, such as looking at the crestal marrow to make sure there are no abnormalities. If during your physical exam your doctor finds subtle neurological abnormalities, or intense pain that is associated with scoliosis, or if the radiographs show abnormal scoliosis, your doctor will recommend an MRI.The likelihood of seeing something abnormal on an MRI is very small, but if something is found that is not normal, further characterization by a neurosurgeon will be needed.