Adolescent idiopathic scoliosis

Last reviewed: 27 Apr 2022
Last updated: 09 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • 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
More key diagnostic factors

Other diagnostic factors

  • shoulder asymmetry
  • waist-line asymmetry
  • thoracic wall or breast asymmetry
  • normal gag reflex
  • truncal decompensation
Other diagnostic factors

Risk factors

  • positive family history
  • peak adolescent growth spurt
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical exam
More 1st investigations to order

Investigations to consider

  • 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
More investigations to consider

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

Joshua M. Eisenberg, MD

Clinical Research Fellow

Department of Orthopaedics and Rehabilitation

University of Iowa Hospitals and Clinics

Iowa City

IA

Disclosures

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

IA

Disclosures

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.

Acknowledgements

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

Disclosures

RMI declared that he had no competing interests.

Peer reviewers

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.

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