Adolescent idiopathic scoliosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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.

Posteroanterior scoliosis radiograph of a 13-year-old girl with a 49° right thoracic curvature with apex at the T9-T10 disc space

From the collection of Stuart Weinstein, MD, University of Iowa; used with permission

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Scoliometer measurement of a right thoracic prominence
Posteroanterior scoliosis radiograph of a 13-year-old girl with a 49° right thoracic curvature with apex at the T9-T10 disc space
Lateral scoliosis radiograph of a 13-year-old girl with a 49° right thoracic curvature
Typical thoracic-lumbar-sacral orthosis (TLSO) scoliosis brace
Thirteen-year-old girl post-posterior spinal instrumentation and fusion for progressive scoliosis
Thirteen-year-old girl post-posterior spinal instrumentation and fusion for progressive scoliosis

Citations

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

Other Online Resources

Scoliosis Research Society

Referenced Articles

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2. 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.
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12. Bunnell WP. The natural history of idiopathic scoliosis before skeletal maturity. Spine. 1986 Oct;11(8):773-6.[Abstract]
13. Hadley Miller N. Spine update: genetics of familial idiopathic scoliosis. Spine. 2000 Sep 15;25(18):2416-8.[Abstract]
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25. Peterson LE, Nachemson AL. Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am. 1995 Jun;77(6):823-7.[Abstract]
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27. Sanders JO, Little DG, Richards BS. Prediction of the crankshaft phenomenon by peak height velocity. Spine. 1997 Jun 15;22(12):1352-6.[Abstract]
28. Harrop JS, Birknes J, Shaffrey CI. Noninvasive measurement and screening techniques for spinal deformities. Neurosurgery. 2008 Sep;63(3 Suppl):46-53.[Abstract]
29. 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.[Abstract][Full Text]
30. Dunn J, Henrikson NB, Morrison CC et al. Screening for adolescent idiopathic scoliosis: a systematic evidence review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jan. Report No.: 17-05230-EF-1. [Abstract][Full Text]
31. 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.[Abstract][Full Text]
32. Scoliosis Research Society. Adolescent idiopathic scoliosis. 2022 [internet publication].[Full Text]
33. Grossman TW, Mazur JM, Cummings RJ. An evaluation of the Adams forward bend test and the scoliometer in a scoliosis school screening setting. J Pediatr Orthop. 1995 Jul-Aug;15(4):535-8.[Abstract]
34. Ashworth MA, Hancock JA, Ashworth L, et al. Scoliosis screening. An approach to cost/benefit analysis. Spine. 1988 Oct;13(10):1187-8.[Abstract]
35. Bunnell WP. An objective criterion for scoliosis screening. J Bone Joint Surg Am. 1984 Dec;66(9):1381-7.[Abstract]
36. Zaoussis AL, James JI. The iliac apophysis and the evolution of curves in scoliosis. J Bone Joint Surg Br. 1958 Aug;40-B(3):442-53.[Abstract][Full Text]
37. Hawary RE, Zaaroor-Regev D, Floman Y, et al. Brace treatment in adolescent idiopathic scoliosis: risk factors for failure-a literature review. Spine J. 2019 Dec;19(12):1917-25.[Abstract][Full Text]
38. Cobb JR. The problem of the primary curve. J Bone Joint Surg Am. 1960 Dec;42-A:1413-25.[Abstract]
39. Yawn B, Yawn RA. Efficacy of school scoliosis screening. Orthopedics. 2001 Apr;24(4):317.[Abstract]
40. Yawn BP. School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece. J Bone Joint Surg Am. 1998 Aug;80(8):1244.[Abstract]
41. Yawn BP. Reassessing scoliosis screening: new definitions, new criteria. Adm Radiol J. 2000;19(8):14-7.[Abstract]
42. Yawn B, Yawn RA. The estimated cost of school scoliosis screening. Spine. 2000 Sep 15;25(18):2387-91.[Abstract]
43. Hresko MT, Talwalkar V, Schwend R, et al. Early detection of idiopathic scoliosis in adolescents. J Bone Joint Surg Am. 2016 Aug 17;98(16):e67.[Abstract]
44. Weinstein SL, Dolan LA, Wright JG, et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013 Oct 17;369(16):1512-21.[Abstract][Full Text]
45. Lonstein JE. Why school screening for scoliosis should be continued. Spine. 1988 Oct;13(10):1198-200.[Abstract]
46. Fong DY, Lee CF, Cheung KM, et al. A meta-analysis of the clinical effectiveness of school scoliosis screening. Spine (Phila Pa 1976). 2010 May 1;35(10):1061-71.[Abstract]
47. Sabirin J, Bakri R, Buang SN, et al. School scoliosis screening programme-a systematic review. Med J Malaysia. 2010 Dec;65(4):261-7.[Abstract][Full Text]
48. Scoliosis Research Society. Position statement - screening for the early detection for idiopathic scoliosis in adolescents. Sept 2015 [internet publication].[Full Text]
49. 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.[Abstract][Full Text]
50. Bagnall KM, Beuerlein M, Johnson P, et al. Pineal transplantation after pinealectomy in young chickens has no effect on the development of scoliosis. Spine. 2001 May 1;26(9):1022-7.[Abstract]
51. Goldberg MS, Mayo NE, Poitras B, et al. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part II: Perception of health, self and body image, and participation in physical activities. Spine. 1994 Jul 15;19(14):1562-72.[Abstract]
52. Weinstein SL. Idiopathic scoliosis. Natural history. Spine. 1986 Oct;11(8):780-3.[Abstract]
53. Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am. 1983 Apr;65(4):447-55.[Abstract]
54. Weinstein SL, Zavala DC, Ponseti IV. Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Joint Surg Am. 1981 Jun;63(5):702-12.[Abstract]
55. Sponseller PD. Bracing for adolescent idiopathic scoliosis in practice today. J Pediatr Orthop. 2011 Jan-Feb;31(1 Suppl):S53-60.[Abstract]
56. Kotwicki T, Durmala J, Czaprowski D, et al. Conservative management of idiopathic scoliosis: guidelines based on SOSORT 2006 Consensus. Ortop Traumatol Rehabil. 2009 Sep-Oct;11(5):379-95.[Abstract]
57. Roye BD, Simhon ME, Matsumoto H, et al. Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis. Spine Deform. 2020 Aug;8(4):597-604.[Abstract]
58. Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev. 2015 Jun 18;(6):CD006850.[Abstract][Full Text]
59. 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]
60. Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine. 2006 Feb 1;31(3):291-8.[Abstract]
61. Lenke LG. Debate: Resolved, a 55 degrees right thoracic adolescent idiopathic scoliotic curve should be treated by posterior spinal fusion and segmental instrumentation using thoracic pedicle screws: Pro: Thoracic pedicle screws should be used to treat a 55 degrees right thoracic adolescent idiopathic scoliosis. J Pediatr Orthop. 2004 May-Jun;24(3):329-34.[Abstract]
62. Suk SI, Lee CK, Kim WJ, et al. Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine. 1995 Jun 15;20(12):1399-405.[Abstract]
63. Suk SI, Lee SM, Chung ER, et al. Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis: more than 5-year follow-up. Spine. 2005 Jul 15;30(14):1602-9.[Abstract]
64. Muschik MT, Kimmich H, Demmel T. Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients. Eur Spine J. 2006 Jul;15(7):1128-38.[Abstract]
65. Turi M, Johnston CE 2nd, Richards BS. Anterior correction of idiopathic scoliosis using TSRH instrumentation. Spine. 1993 Mar 15;18(4):417-22.[Abstract]
66. Newton PO. The use of video-assisted thoracoscopic surgery in the treatment of adolescent idiopathic scoliosis. Instr Course Lect. 2005;54:551-8.[Abstract]
67. Newton PO, Faro FD, Gollogly S, et al. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients. J Bone Joint Surg Am. 2005 Sep;87(9):1937-46.[Abstract]
68. Newton PO, Marks M, Faro F, et al. Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine. 2003 Oct 15;28(20):S249-54.[Abstract]
69. Newton PO, Parent S, Marks M, et al. Prospective evaluation of 50 consecutive scoliosis patients surgically treated with thoracoscopic anterior instrumentation. Spine. 2005 Sep 1;30(17 Suppl):S100-9.[Abstract]
70. Newton PO, Wenger DR, Mubarak SJ, et al. Anterior release and fusion in pediatric spinal deformity. A comparison of early outcome and cost of thoracoscopic and open thoracotomy approaches. Spine. 1997 Jun 15;22(12):1398-406.[Abstract]
71. Newton PO, White KK, Faro F, et al. The success of thoracoscopic anterior fusion in a consecutive series of 112 pediatric spinal deformity cases. Spine. 2005 Feb 15;30(4):392-8.[Abstract]
72. Reddi V, Clarke DV Jr, Arlet V. Anterior thoracoscopic instrumentation in adolescent idiopathic scoliosis: a systematic review. Spine (Phila Pa 1976). 2008 Aug 15;33(18):1986-94.[Abstract]
73. 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]
74. Lenke LG. Anterior endoscopic discectomy and fusion for adolescent idiopathic scoliosis. Spine. 2003 Aug 1;28(15 Suppl):S36-43.[Abstract]
75. Lowe TG, Alongi PR, Smith DA, et al. Anterior single rod instrumentation for thoracolumbar adolescent idiopathic scoliosis with and without the use of structural interbody support. Spine. 2003 Aug 1;28(15 Suppl):S36-43.[Abstract]
76. Mayo NE, Goldberg MS, Poitras B, et al. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part III: back pain. Spine. 1994 Jul 15;19(14):1573-81.[Abstract]
77. Collis DK, Ponseti IV. Long-term follow-up of patients with idiopathic scoliosis not treated surgically. J Bone Joint Surg Am. 1969 Apr;51(3):425-45.[Abstract]
78. 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]
79. Ascani E, Bartolozzi P, Logroscino CA, et al. Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine. 1986 Oct;11(8):784-9.[Abstract]
80. Nachemson A. A long term follow-up study of non-treated scoliosis. Acta Orthop Scand. 1968;39(4):466-76.[Abstract]
81. Branthwaite MA. Cardiorespiratory consequences of unfused idiopathic scoliosis. Br J Dis Chest. 1986 Oct;80(4):360-9.[Abstract]
82. 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.[Abstract][Full Text]
83. Pehrsson K, Bake B, Larsson S, et al. Lung function in adult idiopathic scoliosis: a 20 year follow up. Thorax. 1991 Jul;46(7):474-8.[Abstract][Full Text]
84. Pehrsson K, Danielsson A, Nachemson A. Pulmonary function in adolescent idiopathic scoliosis: a 25 year follow up after surgery or start of brace treatment. Thorax. 2001 May;56(5):388-93.[Abstract][Full Text]
85. Dolan LA, Weinstein SL, Abel MF, et al. Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST): development and validation of a prognostic model in untreated adolescent idiopathic scoliosis using the simplified skeletal maturity system. Spine Deform. 2019 Nov;7(6):890-8.e4.[Abstract][Full Text]
86. Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis. Lancet. 2008 May 3;371(9623):1527-37.[Abstract]
87. Dickson RA. Spinal disorders and low back pain. J Bone Joint Surg Br. 1999 May;81(3):378-9.[Abstract][Full Text]
88. Murphy RF, Mooney JF 3rd. Complications following spine fusion for adolescent idiopathic scoliosis. Curr Rev Musculoskelet Med. 2016 Dec;9(4):462-9.[Abstract]
89. Newton PO, Upasani VV, Lhamby J, et al. Surgical treatment of main thoracic scoliosis with thoracoscopic anterior instrumentation. a five-year follow-up study. J Bone Joint Surg Am. 2008 Oct;90(10):2077-89.[Abstract]
90. Lehman RA Jr, Lenke LG, Keeler KA, et al. Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs: minimum three-year follow-up of one hundred fourteen cases. Spine (Phila Pa 1976). 2008 Jun 15;33(14):1598-604.[Abstract]
91. Fan Y, Ren Q, To MKT, et al. Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review. BMC Musculoskelet Disord. 2020 Jul 27;21(1):495.[Abstract][Full Text]