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Scoliosis X-Rays: Can X-Rays Identify A Scoliosis?

scoliosis x ray

In order for structural scoliosis to be given as a diagnosis, certain condition characteristics have to be met. Structural scoliosis involves having an abnormal sideways curvature to the spine, but that curvature has to be of a certain size, and there has to be rotation present. In addition, scoliosis X-rays tell us what we need to know to design an effective treatment plan moving forward, such as the type and location of the curvature.

Scoliosis X-rays remain the gold standard for diagnosing, assessing, and monitoring scoliosis. They tell us how much a scoliotic spine deviates from a straight alignment via a measurement known as ‘Cobb angle’, if there is rotation present, and if the condition fulfills the definition of structural scoliosis.

When it comes to a progressive spinal condition like scoliosis, in addition to diagnosing and assessing it, monitoring the spine throughout treatment, as needed, to see how it is responding is very important. Before we move on to the specifics of scoliosis X-rays and what they can tell us, let’s first talk generally about scoliosis.

What it Means to Have Scoliosis

As mentioned, scoliosis means having an abnormally-curved spine. While a healthy spine has natural curvatures that give it added strength, flexibility, and help it distribute mechanical stress throughout, an unhealthy spine can develop unnatural curvatures that disrupt the spine’s biomechanics and overall function.

When scoliosis develops, the spine abnormally curves to the side, and if certain condition characteristics are met, a diagnosis of structural scoliosis is given. There is a difference between nonstructural and structural scoliosis as the former is temporary, commonly caused by bad posture, and the curvature does not involve rotation: a key element of scoliosis.

Now, let’s move on to the parameters that have to be met for a structural scoliosis diagnosis to be given, and the role that X-rays play.

Diagnosing Scoliosis

When a young patient comes to see me with concerns about scoliosis, it’s often because a routine physical has spotted an abnormal spinal curvature.

While scoliosis is incurable and progressive, it is highly treatable, but before the first steps on the road to treatment can be taken, I need accurate assessment and measurements, and this is achieved with the scoliosis X-ray.

While scoliosis can develop at any age and take many forms, the most prevalent condition type is adolescent idiopathic scoliosis (AIS) diagnosed between the ages of 10 and 18.

To officially diagnose scoliosis, I conduct a physical exam with many tests, including taking the patient’s medical history and watching how they walk; I can tell a lot about a patient’s condition by how they walk.

Often, the asymmetries produced by scoliosis are more noticeable when in a forward-bend position. If I see indicators for the condition, a scoliosis X-ray is the next step to reaching a diagnosis.

Scoliosis X-Rays: Can X-Rays Identify a Scoliosis?

What a Scoliosis X-ray Can Tell Us

A scoliosis X-ray can tell us what we need to know about a condition to treat it effectively. It tells us if the abnormal spinal curvature includes rotation, how severe the curvature is, what type of curvature it is, and where along the spine the curvature has developed.

For an official scoliosis diagnosis to be given, there has to be rotation, and the curvature has to have a minimum Cobb angle measurement of 10 degrees.

Cobb angle is measured by drawing intersecting lines from the tops and bottoms of the curvature’s most-tilted vertebrae, and the resulting angle is measured in degrees.

A patient’s Cobb angle is one of the most important pieces of information; it gives us a starting point from which we can monitor treatment progress and places the condition on its severity scale of mild, moderate, severe, or very severe.

  • Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
  • Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
  • Severe scoliosis: Cobb angle measurement of 40+ degrees
  • Very-severe scoliosis: Cobb angle measurement of 80+ degrees

As scoliosis is progressive, this means its nature is to worsen over time, especially if left untreated.

Placing a condition on its severity scale, plus other condition characteristics such as curvature location and type, help us predict a patient’s likeliest rate of progression; I say ‘likeliest’ because there is no way to predict, with 100-percent accuracy, how much or how quickly a patient’s condition will progress.

Certain curvature patterns, such as thoracic curves, tend to progress faster, so knowing the location of the curvature along the spine can give us more progression-related guidance.

X-ray images can also tell us if a scoliosis is considered typical or atypical; most scoliosis curvatures bend to the right, away from the heart, but if an X-ray shows a curvature bending to the left, towards the heart, this tells me it is an atypical case, likely with another condition/disease causing the scoliosis as a secondary complication.

Every case of scoliosis is different, which is why a customized treatment approach is so important. For a treatment plan to be effective, it has to address the specifics of each patient and their condition, which is why X-ray results are so important.

while there are other methods 400While there are other methods of diagnosing and assessing scoliosis, none are as accurate, accessible, and cost-effective as the X-ray.

It is extremely important, however, that the practitioner performing the X-ray has the scoliosis-specific training, experience, and knowledge to interpret the results of the 3-dimensional condition so an effective treatment plan can be crafted.

Reading 2-Dimensional Images of a 3-Dimensional Condition

Scoliosis is a 3-dimensional condition, meaning it doesn’t just bend to the side, but also twists, which is the rotation factor.

In order for the condition to be impacted on a structural level effectively, it has to be treated as a 3-dimensional condition, which is why it’s so important to be able to conduct and read a scoliosis X-ray comprehensively.

While traditional X-rays provide 2-dimensional images, experts who specialize in scoliosis understand how to use multiple X-rays to construct a complete picture of the spine from side to side, front to back, and back to front.

Without the proper expertise, the proper measurements needed to treat scoliosis effectively can’t be taken, and this can impact treatment efficacy, which is why it’s so important to enlist the help of a practitioner who specializes in scoliosis.

When scoliosis patients come to see me here at the Scoliosis Reduction Center, I use multiple measurements to assess their condition. By looking at the spine from several different angles, I can measure twist, tilt, and other important factors.

There is more to measuring scoliosis than just the Cobb angle, and crafting an effective treatment plan is only possible when the condition is assessed from all angles.

How to Read a Scoliosis X-Ray

Here at the Center, we rely on X-rays every day to diagnose, assess, and manage our patients’ scoliosis, when necessary, but there are a few things that set us apart:

  • we use the most advanced 400We use the most advanced digital scoliosis X-ray technology to give us the greatest accuracy with the least amount of radiation exposure.
  • We use small, specifically-targeted X-rays to assess the biomechanical integrity of the spine and gain more precise measurements.
  • As my focus is scoliosis, I’ve measured thousands of scoliosis X-rays and have the ability to craft more precise, patient-specific, and effective treatment plans.
  • I use scoliosis X-rays throughout treatment, when needed, to gauge progress, apply specific targeted chiropractic adjustments, prescribe scoliosis-specific exercises, and make sure a patient’s condition is being treated in the most effective and efficient manner possible.

While not necessary for every patient, I also have access to Digital Motion X-ray, which can be helpful in isolating and assessing the source of spinal instability and scoliosis-related pain during movement.

Digital Motion X-Ray

In addition to traditional static X-ray, I also utilize Digital Motion X-ray when an individual case necessitates it.

Digital Motion X-ray (DMX) is a medical-imaging technology that can visualize the body while in motion, providing video images of how the bones are engaged during movement. This is particularly beneficial for patients who are experiencing a lot of pain and isolating its source.

DMX is an innovative diagnostic tool that can be used to visualize all joints in the body during real-time motion. DMX can reveal spinal instability, and as joint-related pain is generally at its worst during motion, having scans produced while a patient is experiencing symptoms can help me design the most effective treatment plan for addressing those symptoms.

DMX offers excellent resolution and a large dynamic range, allowing for complete and precise measurements used in orthopedic applications.

However, the use of DMX for every patient is unnecessary because as a CLEAR-certified scoliosis chiropractor following the CLEAR approach, I take approximately 77 different measurements via static X-ray, which is far more than what a general chiropractor or medical doctor is assessing.

As my focus is scoliosis, I have the knowledge and ability to utilize standard 2-dimensional X-ray images in such a way that I can fully construct a 3-dimensional picture of what is happening with the spine and design an effective and customized treatment plan moving forward.


While there are a number of screening and assessment methods used for scoliosis, X-rays provide the most safe, reliable, accessible, and cost-effective means of doing so.

Scoliosis X-ray results tell me everything I need to know about a patient’s condition to treat it effectively. While scoliosis is a 3-dimensional condition and standard X-rays produce 2-dimensional images, I have the scoliosis-specific certifications, experience, and knowledge to interpret the images comprehensively, in order to provide patients with the best information and most effective treatment plans.

Not only does performing scoliosis X-rays, when needed, allow me to effectively identify the condition, they provide me with enough information to craft an effective treatment plan, and the means by which I can monitor how the spine is responding to treatment.

The important thing to remember, when it comes to scoliosis X-rays, is that the information they provide can only be shaped into effective treatment plans if the spine is being looked at from multiple angles, addressing the condition’s 3-dimensional nature.

Here at the Scoliosis Reduction Center, we have access to the latest X-ray technology and take measurements of the spine from several different angles to measure twist, tilt, and other important condition characteristics.

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Ready to discuss next steps for scoliosis treatment? Reach out to us here.
Dr. Tony Nalda
Doctor of Chiropractic
Severe migraines as a young teen introduced Dr. Nalda to chiropractic care. After experiencing life changing results, he set his sights on helping others who face debilitating illness through providing more natural approaches.

After receiving an undergraduate degree in psychology and his Doctorate of Chiropractic from Life University, Dr. Nalda settled in Celebration, Florida and proceeded to build one of Central Florida’s most successful chiropractic clinics.

His experience with patients suffering from scoliosis, and the confusion and frustration they faced, led him to seek a specialty in scoliosis care. In 2006 he completed his Intensive Care Certification from CLEAR Institute, a leading scoliosis educational and certification center.
About Scoliosis Reduction Center
Welcome to Scoliosis Reduction Center. Our team, under the leadership of Dr. Tony Nalda, is focused on treating your scoliosis in the most patient-centered, effective manner possible.
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