Current concepts and controversies on adolescent idiopathic scoliosis: Part I

Abstract

Adolescent idiopathic scoliosis is the most common spinal deformity encountered by General Orthopaedic Surgeons. Etiology remains unclear and current research focuses on genetic factors that may influence scoliosis development and risk of progression. Delayed diagnosis can result in severe deformities which affect the coronal and sagittal planes, as well as the rib cage, waistline symmetry, and shoulder balance. Patient's dissatisfaction in terms of physical appearance and mechanical back pain, as well as the risk for curve deterioration are usually the reasons for treatment. Conservative management involves mainly bracing with the aim to stop or slow down scoliosis progression during growth and if possible prevent the need for surgical treatment. This is mainly indicated in young compliant patients with a large amount of remaining growth and progressive curvatures. Scoliosis correction is indicated for severe or progressive curves which produce significant cosmetic deformity, muscular pain, and patient discontent. Posterior spinal arthrodesis with Harrington instrumentation and bone grafting was the first attempt to correct the coronal deformity and replace in situ fusion. This was associated with high pseudarthrosis rates, need for postoperative immobilization, and flattening of sagittal spinal contour. Segmental correction techniques were introduced along with the Luque rods, Harri-Luque, and Wisconsin systems. Correction in both coronal and sagittal planes was not satisfactory and high rates of nonunion persisted until Cotrel and Dubousset introduced the concept of global spinal derotation. Development of pedicle screws provided a powerful tool to correct three-dimensional vertebral deformity and opened a new era in the treatment of scoliosis.

Incidence of spinal deformity surgery in a national health service from 2005 to 2018

“…Idiopathic scoliosis represents around 80% of all paediatric patients with spinal deformity. 1 Depending upon age at onset this can be classified into infantile (< 3 years), juvenile (4 to 9 years), and adolescent (10 to 18 years) which is the most common having a prevalence of approximately 2% to 3% in most populations. 2 , 3 Other types of scoliosis include neuromuscular, congenital, syndromic, and scoliosis associated with congenital cardiac disease or intraspinal anomalies.…”

“…Bracing is used in skeletally-immature patients with progressive curves < 40° either as the only treatment or as a temporizing measure to delay scoliosis surgery for a later age while preserving spinal growth. 1 Scoliosis surgery is indicated if the curve progresses over 40° to 50°, nonoperative management has failed, or in the presence of significant symptoms. Surgery usually comprises spinal fusion, which can be performed through an anterior or posterior approach to the spine.…”

Efficacy of conservative treatment on exacerbation of adolescent idiopathic scoliosis

“…People with AIS are usually asymptomatic, but the resulting surface anomalies can negatively affect adolescent patients. Additionally, increased curvature of the spine may pose health risks in adulthood ( Sud and Tsirikos, 2013 ). In order to maximize the effect of treatment, the degree of curvature, the affected area, the balance of the trunk, overall health, function and satisfaction, and the treatment needs of patients and parents are should be satisfied ( Motyer et al, 2021 ; Wong and Tan, 2010 ).…”

Minimally Invasive Scoliosis Surgery Is a Feasible Option for Management of Idiopathic Scoliosis and Has Equivalent Outcomes to Open Surgery: A Meta-Analysis

“…Defined as a coronal Cobb angle >10 degrees, idiopathic scoliosis is the most common spinal disorder in pediatric and adolescent populations, occurring in approximately 1-3% of the community. [1][2][3][4][5] While mild curves occur with high frequency, the incidence of AIS based on the magnitude of deformity varies, with severe deformity being less common. Curves >10 degrees, for example, have an incidence of 1-3%, whereas the incidence decreases to 0.15% to 0.3% for curves of >30 degrees.…”