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Skeletal Radiol. 2009 Mar;38(3):207-23. Imaging of painful scoliosis. Davies A, Saifuddin A. Department of Radiology, Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex, London, HA7 4LP, UK. Scoliosis is defined as a lateral deviation of the spine from the normal plumb line. Commonly, there is a rotational component and deviation also in the sagittal plane (kyphosis or hyperlordosis). When scoliosis presents in adults, it is often painful. In contrast, back pain in a child is considered rare, and serious underlying pathology should be excluded, particularly since idiopathic scoliosis is typically painless. A painful scoliosis in a child or adolescent, especially if the patient has a left-sided curve, should be examined thoroughly. The aim of this review is to illustrate the causes of a painful scoliosis in children, adolescents and adults.