Scoliosis and Kyphosis

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Introduction

Scoliosis is a sideways curvature of the spine usually becoming evident after 10 years old.

There are several types of scoliosis:

idiopathic
neuromuscular
syndromic
congenital

Symptoms may include uneven shoulders, one shoulder blade appearing more prominent, uneven hips or waist.

Kyphosis occurs when the vertebrae of the spine change shape, causing an increased rounding through the chest. This can appear at any time. Kyphosis can be caused by multiple things such as spinal fractures, osteoporosis, spinal birth defects or Scheuermann's Disease.

Pre-referral assessment and guidance

History – family history, pain or neurology is a red flag, menarche onset
Physical examination – look for any shoulder, trunk, rib or waist asymmetry. Observe for any leg length discrepancy.
EOS Spine AP / Lat
- low dose imaging and improved accuracy in measurements
- Cobb angle
- necessary for triaging (no referral accepted if less than 10 degrees).
Cobb angles of less than 10 / kyphosis of less than 50 degrees are normal variants.

When to refer

Refer to Orthopaedics:

Under 15 years of age ALL patients with a Cobb angle greater than 15 degrees
ALL patients with a structural kyphosis greater than 50 degrees
Over 15 years of age – refer to Royal Perth Hospital
Any scoliotic curve in children with underlying conditions that predispose to scoliosis (neuromuscular, congenital, syndromic, genetic, bone dysplasias)

How to refer

Routine referrals from a GP or a Consultant are made via the Central Referral Service
Routine referrals from private hospitals are made via the PCH Referral Office
- Fax: (08) 6456 0097
- Email
Urgent referrals (less than 7 days) are made via the PCH Referral Office.
- Please call Perth Children's Hospital Switch on (08) 6456 2222 to discuss referral with the Orthopaedic registrar.

Essential information to include in your referral

Patient demographics
EOS written report from the radiology service
- Cobb angle must be reported
Female patients - Menarchal status / onset of menarche if post menarchal.
Presence of any red flags
- Male, back pain limiting activities, neurological history or signs, kyphosis

Useful resources

References

Scheuermanns Disease | Royal Children's Hospital

Reviewer/Team:	Orthopaedics Department	Last reviewed:	Jan 2026
		Next review date:	Jan 2029

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