Adolescent idiopathic scoliosis

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

Last reviewed: 1 Apr 2025

Last updated: 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.

Definition

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]

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

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 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

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

Joshua M. Eisenberg, MD

Clinical Research Fellow

Department of Orthopaedics and Rehabilitation

University of Iowa Hospitals and Clinics

Iowa City

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

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

Disclosures

JMF declares that he has no competing interests.

Amer Samdani, MD

Director

Pediatric Spine Surgery

Shriners Hospitals for Children

Philadelphia

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.

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

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

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. Abstract

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

Harrop JS, Birknes J, Shaffrey CI. Noninvasive measurement and screening techniques for spinal deformities. Neurosurgery. 2008 Sep;63(3 Suppl):46-53. 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;13:3.Full text Abstract

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

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.Full text Abstract

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

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. Abstract

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. Abstract

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. Abstract

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.Full text Abstract

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

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
- 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

Joshua M. Eisenberg, MD

Disclosures

Stuart L. Weinstein, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

John M. (Jack) Flynn, MD

Disclosures

Amer Samdani, MD

Disclosures

Andre Tomasino, MD

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