Most patients with degenerative scoliosis are older than 50 years old, and with the aging of our population, adult scoliosis will become more common. The main focus is on symptomatic relief, and under the premise of being able to ensure a certain quality of life for the patient, simple, convenient and less invasive treatments are chosen as much as possible. In this issue, we will introduce the various diagnostic modalities of degenerative scoliosis, including symptoms, physical examination and imaging tests. Symptoms The main symptoms of patients with degenerative scoliosis are lumbago, radiating pain in the lower limbs and intermittent claudication. Low back pain is the most common first symptom and the main symptom, which can last for several months to decades. Back pain occurs when loaded upright position, sitting position and squatting rest can not be relieved, lying position can be significantly relieved, so it is also known as “postural back pain”. There are also patients with progressive aggravation of low back pain symptoms, seriously affecting normal life, rest and require hospitalization.DS pain can be manifested as mechanical pain, spinal stenosis pain or a mixture of the two types of pain. It is now generally accepted that it is not easy to determine the exact site of origin of the pain and that scoliosis may be only one of the causes of the pain. Muscle fatigue and strain on the convex side may be the most important cause of pain, and symptoms may be significantly worsened by lumbar extension activities; whereas when pain occurs on the concave side, the symptoms mainly originate from degeneration of the intervertebral discs, small joints, and so on. Scoliosis combined with lumbar anterior kyphosis angle becomes small pain is more obvious. 2.Scoliosis Most of the patients have lumbar curvature and thoracolumbar segment curvature, among which lumbar curvature is the most common. In male DS patients, the left lateral convexity and right lateral convexity of the main curvature were roughly equal, and the left lateral convexity was significantly more than the right lateral convexity in female patients. The angle of lateral convexity is smaller than that of adults, and the involved segments are usually smaller; the position of the parietal vertebrae is usually located in L2~L3 or L3~L4, and may also be located in L1 and L2, which is mostly accompanied by intervertebral transverse displacement, vertebral body rotation, and spinal canal stenosis. 3.Nerve root compression symptoms Nerve root symptoms such as radiating pain, numbness and weakness of the lower limbs can occur in both lower limbs. Generally, radiating pain is more common in the convex side of the lower limbs, and the rest of the symptoms are more common in the concave side of the lower limbs. l4/l5 nerve root compression is the most common. Nerve root compression may be caused by pulling and compression of the nerve root due to displacement of the arch root, vertebral rotation, lateral slip joint synostosis, lateral socket stenosis, intervertebral disc herniation, and change in the line of negative gravity. Defining the cause of nerve root compression will help to define the scope of surgical decompression. Neurogenic claudication is caused by the combination of degeneration and lateral bending deformity leading to lumbar spinal canal stenosis. Spinal stenosis most often occurs in the parietal vertebral segments of the main bend of lateral bending (either concave or convex), and is accompanied by varying degrees of structural rotational deformity. Characteristically, patients cannot achieve symptomatic relief by lumbar forward flexion alone or by adopting a seated position; these patients need to use their upper extremities to support the trunk or to adopt a supine position, which allows them to relieve their neurologic claudication symptoms. Symptoms of neurologic claudication and vascular claudication may overlap and require careful evaluation. Physical examination In addition to the general condition, the standing posture and gait, whether the shoulders and pelvis are tilted or horizontal, whether there is a flat back or retroverted deformity of the low back, razorback deformity when bending over, abdominal collapse, skin folds, etc. Detailed neurological examination including muscle strength, sensation, physiological and pathological reflexes, straight-leg raising test, femoral nerve pull test, etc. is also required. The pulse beat of the distal side of the limb must be checked to help exclude peripheral vascular disease and vascular claudication. III. Imaging examination X-ray examination: it is required to routinely take a full spinal image in the standing position. Degenerative scoliosis is well defined with isolated lumbar scoliosis and degenerative disc changes. In some patients, there may be a reduction in normal lumbar lordosis and significant lumbar rotational subluxation with varying degrees of lateral displacement of the vertebrae. Lateral flexion films can provide additional information when planning surgery. Flexion-extension lateral views can show lumbar instability, and Ferguson anteroposterior images can show significant degenerative changes in the lumbosacral joints and better visualization of the transverse process of L5. The presence of transverse process hypoplasia also suggests consideration of interbody fusion, as the implant bed is too small for intertransverse process implantation in this case, especially in lumbosacral fusion. CT, MRI examination: It can provide reliable information on the internal diameter of the spinal canal, the degree and extent of spinal cord and nerve root compression, and the degeneration of the intervertebral discs in the relevant segments, which is indispensable for the diagnosis and treatment of the disease. Myelography CT examination (CTM): Since it is difficult to obtain images parallel to the intervertebral disc space when MRI is performed in patients with scoliosis, it is better to use myelography in showing the spinal canal and nerve roots. A myelogram should be taken of the patient in the flexion and extension positions in the standing position, which must be followed by a CT examination. Images in the power position can show compression of the nerve roots that cannot be visualized in the supine position. Other: Electromyography (EMG) and examination of nerve conduction velocities are helpful in differentiating peripheral neuropathy from other diseases, especially in diabetic patients. In addition, arterial Doppler and angiography are needed for some patients, and the bicycle-plate test, a noninvasive functional test, is also helpful in differentiating neurologic and vascular claudication. Diagnosis and differential diagnosis According to the clinical characteristics of degenerative scoliosis, patients should be asked about their medical history in detail, focusing on whether there is a family history of scoliosis, whether there is back pain, whether there is neurogenic claudication, whether there is spinal imbalance or obvious deformity, and the time of the appearance of these symptoms. Physical examination In addition to a complete neurologic examination, a pelvic, low back, trunk, and shoulder examination should be performed to measure range of motion and lower extremity length. Imaging should be performed first with upright posterior anterior and lateral radiographs, followed by anterior flexion, posterior extension, and lateral flexion positions to further assess the flexibility of the scoliosis and the stability of the motor segments. Myelography, CT or MRI may be used to diagnose spinal canal or foraminal stenosis, among others. It needs to be differentiated from adult idiopathic scoliosis (IS).IS is more common before the age of 30 years and is more common in the thoracic segments, followed by the thoracolumbar segments, and less common in the lumbar area alone.IS can involve 7-11 segments, and the Cobb’s angle is often large, but there are often no neurologic symptoms. In addition, in older patients with recent symptoms of low back pain, despite the presence of degenerative scoliosis, tumors or other diseases such as osteoporosis, diabetes mellitus, and cardiopulmonary disease should be ruled out.