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.
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.
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
Other diagnostic factors
- shoulder asymmetry
- waist-line asymmetry
- thoracic wall or breast asymmetry
- normal gag reflex
- truncal decompensation
- positive family history
- peak adolescent growth spurt
1st investigations to order
- clinical exam
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
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°
- Congenital scoliosis
- Neuromuscular scoliosis
- Adolescent idiopathic scoliosis
- Screening for adolescent idiopathic scoliosis: a systematic evidence review for the U.S. Preventive Services Task Force
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