Adolescent idiopathic scoliosis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Evidence last reviewed: 5 Apr 2026

Topic last updated: 01 May 2026

Adolescent idiopathic scoliosis (AIS) develops between the age of 10 years and skeletal maturity.

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.

Treatment options include observational monitoring, bracing, or surgical spinal arthrodesis (fusion). The vast majority of patients will never require any form of treatment during their lifetime.

Patients with a curvature >45° during growth are at high 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.

Curves >40° degrees at maturity should be monitored periodically as they may progress even after skeletal maturity.

Definition

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]

Infantile idiopathic scoliosis develops before the age of 3 years, with a male-to-female ratio of 3:2, and accounts for <1% of idiopathic scoliosis cases; juvenile idiopathic scoliosis accounts for the remainder and develops between the ages of 3 and 10 years. Together, infantile and juvenile idiopathic scoliosis are referred to as early onset scoliosis.[2]

History and exam

Key diagnostic factors

age >10 years
signs of the adolescent growth spurt
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

Full details

Other diagnostic factors

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

Full details

Risk factors

positive family history
peak adolescent growth spurt

Full details

Diagnostic tests

1st tests to order

clinical exam

Full details

Tests to consider

standing posteroanterior 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

Full details

Treatment algorithm

ONGOING

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°

Contributors

Authors

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, IA

Disclosures

SLW has received royalties from Wolters Kluwer for text book editing. SLW serves as a member of board of trustees for orthopedic research and education foundation; and he is an author of several references cited in this topic.

Acknowledgements

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

Disclosures

JME and RMI declared that they had no competing interests.

Peer reviewers

Soroush Baghdadi, MD

Fellow

Northwestern University

Evanston, IL

Disclosures

SB declares that he has no competing interests.

John Francis Sarwark, MD

Attending Physician

Northwestern University

Evanston, IL

Disclosures

JFS declares that he has no competing interests.

John M. (Jack) Flynn, MD

Associate Chief of Orthopaedic Surgery

The Children's Hospital of Philadelphia

Philadelphia, PA

Disclosures

JMF declares that he has no competing interests.

Amer Samdani, MD

Director

Pediatric Spine Surgery

Shriners Hospitals for Children

Philadelphia, PA

Disclosures

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

Andre Tomasino, MD

Neurosurgeon

Department of Neurosurgery

Hospital Munich-Bogenhausen

Munich

Germany

Disclosures

AT declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for adolescent idiopathic scoliosis: US Preventive Services Task Force recommendation statement. JAMA. 2018 Jan 9;319(2):165-72.Full text Abstract

Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3.Full text Abstract

British Scoliosis Society. Standards of care for bracing in adolescent idiopathic scoliosis. Jul 2022 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Congenital scoliosis
- Neuromuscular scoliosis
- Syringomyelia
More Differentials
Guidelines
- Standards of care for bracing in adolescent idiopathic scoliosis
- Screening for adolescent idiopathic scoliosis: a systematic evidence review for the U.S. Preventive Services Task Force
More Guidelines
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Adolescent idiopathic scoliosis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

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°

Contributors

Authors

Stuart L. Weinstein, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Soroush Baghdadi, MD

Disclosures

John Francis Sarwark, MD

Disclosures

John M. (Jack) Flynn, MD

Disclosures

Amer Samdani, MD

Disclosures

Andre Tomasino, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice