Adolescent idiopathic scoliosis

Visão geral 
Teoria 
Diagnóstico 
Tratamento 
ACOMPANHAMENTO 
Recursos 

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Última revisão: 13 Apr 2025

Última atualização: 09 Mar 2022

Adolescent idiopathic scoliosis (AIS) develops between the ages of 10 and 18 years.

AIS accounts for approximately 90% of idiopathic scoliosis cases.

The diagnosis is one of exclusion and is made after ruling out other causes of spinal deformity such as neuromuscular, congenital, or syndromic disorders.

The vast majority of patients will never require any form of treatment during their lifetime.

Patients with a severe curvature are at risk of further curve progression and may develop long-term problems related to the degree of the deformity caused by this curvature and/or back pain.

It is uncertain whether nonsurgical management (i.e., bracing) is efficacious in the treatment of patients with a severe curvature.

Modern surgical techniques have provided a safe treatment option resulting in excellent deformity correction and good long-term patient reported outcomes.

Definição

Adolescent idiopathic scoliosis (AIS) is a structural spinal deformity characterized by decompensation of the normal vertebral alignment during rapid skeletal growth in otherwise healthy children. The deformity can be described in terms of altered sagittal and coronal balance as well as abnormal vertebral rotation. This topic focuses on AIS, as this form of idiopathic scoliosis accounts for the vast majority (approximately 90%) of cases.[1]

História e exame físico

Principais fatores diagnósticos

age >10 years
6 to 12 months post puberty
postural asymmetry
absent or minimal pain
absence of neurologic symptoms with normal neurologic exam
paraspinal prominences on forward bending
scoliometer measurement of >5° at paraspinal prominence
symmetric abdominal reflexes

Detalhes completos

Outros fatores diagnósticos

shoulder asymmetry
waist-line asymmetry
thoracic wall or breast asymmetry
normal gag reflex
truncal decompensation

Detalhes completos

Fatores de risco

positive family history
peak adolescent growth spurt

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical exam

Detalhes completos

Investigações a serem consideradas

standing PA x-rays of cervical, thoracic, and lumbar spine, and pelvis
standing lateral x-rays of cervical, thoracic, and lumbar spine, and pelvis
MRI of cervical, thoracic, lumbar, and sacral spine, and brainstem

Detalhes completos

Algoritmo de tratamento

CONTÍNUA

screening scoliometer measurement <5° or coronal Cobb angle measurement of ≤10°

standing coronal Cobb angle measurement of 11° to 20°

standing coronal Cobb angle measurement of 21° to 45°

standing coronal Cobb angle measurement of >45°

Colaboradores

Autores

Joshua M. Eisenberg, MD

Clinical Research Fellow

Department of Orthopaedics and Rehabilitation

University of Iowa Hospitals and Clinics

Iowa City

Declarações

JME declares that he has no competing interests.

Stuart L. Weinstein, MD

Ignacio V. Ponseti Chair and Professor of Orthopaedics

Department of Orthopaedics and Rehabilitation

University of Iowa Hospitals and Clinics

Iowa City

Declarações

SLW has received royalties from Wolters Kluwer for text book editing. SLW is a former board member of the Journal of Bone and Joint Surgery (ended in 2013); he was involved in a NIH RO1 research grant programme until 2015; and he is an author of several references cited in this topic.

Agradecimentos

Dr Stuart L. Weinstein and Dr Joshua M. Eisenberg would like to thank Dr Ryan M. Ilgenfritz, a previous contributor to this topic.

Declarações

RMI declared that he had no competing interests.

Revisores

John M. (Jack) Flynn, MD

Associate Chief of Orthopaedic Surgery

The Children's Hospital of Philadelphia

Philadelphia

Declarações

JMF declares that he has no competing interests.

Amer Samdani, MD

Director

Pediatric Spine Surgery

Shriners Hospitals for Children

Philadelphia

Declarações

AS is a paid consultant for Synthes Spine, Depuy Spine, and SpineVision.

Andre Tomasino, MD

Neurosurgeon

Department of Neurosurgery

Hospital Munich-Bogenhausen

Munich

Germany

Declarações

AT declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Parent S, Newton PO, Wenger DR. Adolescent idiopathic scoliosis: etiology, anatomy, natural history, and bracing. Instr Course Lect. 2005;54:529-36. Resumo

Yaszay B, Newton PO. Idiopathic scoliosis. In: Weinstein SL, Flynn JM, Crawford HA, eds. Lovell and Winter's Pediatric Orthopaedics. 8th ed. Philadelphia: Wolters Kluwer, 2021:659-720.

Lenke LG, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001 Aug;83(8):1169-81. Resumo

Cheng JC, Castelein RM, Chu WC, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015 Sep 24;1:15030. Resumo

Harrop JS, Birknes J, Shaffrey CI. Noninvasive measurement and screening techniques for spinal deformities. Neurosurgery. 2008 Sep;63(3 Suppl):46-53. Resumo

Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3.Texto completo Resumo

Yawn B, Yawn RA. Efficacy of school scoliosis screening. Orthopedics. 2001 Apr;24(4):317. Resumo

Weinstein SL, Dolan LA, Spratt KF, et al. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003 Feb 5;289(5):559-67.Texto completo Resumo

Weinstein SL. Idiopathic scoliosis. Natural history. Spine. 1986 Oct;11(8):780-3. Resumo

Dickson JH, Mirkovic S, Noble PC, et al. Results of operative treatment of idiopathic scoliosis in adults. J Bone Joint Surg Am. 1995 Apr;77(4):513-23. Resumo

Betz RR, Harms J, Clements DH 3rd, et al. Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis. Spine. 1999 Feb 1;24(3):225-39. Resumo

Danielsson AJ, Nachemson AL. Back pain and function 22 years after brace treatment for adolescent idiopathic scoliosis: a case-control study-part I. Spine (Phila Pa 1976). 2003 Sep 15;28(18):2078-85; discussion 2086. Resumo

Edgar MA, Mehta MH. Long-term follow-up of fused and unfused idiopathic scoliosis. J Bone Joint Surg Br. 1988 Nov;70(5):712-6.Texto completo Resumo

Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis. Lancet. 2008 May 3;371(9623):1527-37. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Congenital scoliosis
- Neuromuscular scoliosis
- Syringomyelia
Mais Diagnósticos diferenciais
Diretrizes
- Adolescent idiopathic scoliosis
- Screening for adolescent idiopathic scoliosis: a systematic evidence review for the U.S. Preventive Services Task Force
Mais Diretrizes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal

Adolescent idiopathic scoliosis

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

screening scoliometer measurement <5° or coronal Cobb angle measurement of ≤10°

standing coronal Cobb angle measurement of 11° to 20°

standing coronal Cobb angle measurement of 21° to 45°

standing coronal Cobb angle measurement of >45°

Colaboradores

Autores

Joshua M. Eisenberg, MD

Declarações

Stuart L. Weinstein, MD

Declarações

Agradecimentos

Declarações

Revisores

John M. (Jack) Flynn, MD

Declarações

Amer Samdani, MD

Declarações

Andre Tomasino, MD

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice