UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2015 UpToDate®

Adolescent idiopathic scoliosis: Management and prognosis

Author
Susan A Scherl, MD
Section Editor
William Phillips, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Scoliosis, lateral curvature of the spine, is a structural alteration that occurs in a variety of conditions. Progression of the curvature during periods of rapid growth can result in significant deformity, which may be accompanied by cardiopulmonary compromise.

The treatment and prognosis of AIS will be reviewed here. The clinical features, diagnosis, and initial evaluation are discussed separately. (See "Adolescent idiopathic scoliosis: Clinical features, evaluation, and diagnosis".)

TERMINOLOGY

AIS is scoliosis with Cobb angle ≥10° (image 1), age of onset ≥10 years, and no underlying etiology (eg, congenital, neuromuscular, syndromic). (See "Adolescent idiopathic scoliosis: Clinical features, evaluation, and diagnosis".)

RISK FOR PROGRESSION

The risk for progression of AIS has implications for management. However, it is impossible to predict with complete accuracy which curves will progress and which will not [1].

Clinical predictors — Curves progress in approximately two-thirds of skeletally immature patients before they reach skeletal maturity [1,2]. Natural history studies indicate that the magnitude of progression is increased in:

                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: May 2015. | This topic last updated: May 20, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc.
References
Top
  1. 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; 77:823.
  2. Bunnell WP. The natural history of idiopathic scoliosis before skeletal maturity. Spine (Phila Pa 1976) 1986; 11:773.
  3. Bunnell WP. Selective screening for scoliosis. Clin Orthop Relat Res 2005; :40.
  4. Weinstein SL. Adolescent idiopathic scoliosis: prevalence and natural history. Instr Course Lect 1989; 38:115.
  5. Lonstein JE, Winter RB. The Milwaukee brace for the treatment of adolescent idiopathic scoliosis. A review of one thousand and twenty patients. J Bone Joint Surg Am 1994; 76:1207.
  6. Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am 1983; 65:447.
  7. Nachemson AL, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 1995; 77:815.
  8. Tan KJ, Moe MM, Vaithinathan R, Wong HK. Curve progression in idiopathic scoliosis: follow-up study to skeletal maturity. Spine (Phila Pa 1976) 2009; 34:697.
  9. Lonstein JE, Carlson JM. The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 1984; 66:1061.
  10. Lonstein JE. Adolescent idiopathic scoliosis. Lancet 1994; 344:1407.
  11. Miller NH. Idiopathic scoliosis: cracking the genetic code and what does it mean? J Pediatr Orthop 2011; 31:S49.
  12. Ogilvie JW. Update on prognostic genetic testing in adolescent idiopathic scoliosis (AIS). J Pediatr Orthop 2011; 31:S46.
  13. Ward K, Ogilvie JW, Singleton MV, et al. Validation of DNA-based prognostic testing to predict spinal curve progression in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2010; 35:E1455.
  14. Roye BD, Wright ML, Williams BA, et al. Does ScoliScore provide more information than traditional clinical estimates of curve progression? Spine (Phila Pa 1976) 2012; 37:2099.
  15. Ogura Y, Takahashi Y, Kou I, et al. A replication study for association of 53 single nucleotide polymorphisms in a scoliosis prognostic test with progression of adolescent idiopathic scoliosis in Japanese. Spine (Phila Pa 1976) 2013; 38:1375.
  16. Tang QL, Julien C, Eveleigh R, et al. A replication study for association of 53 single nucleotide polymorphisms in ScoliScore test with adolescent idiopathic scoliosis in French-Canadian population. Spine (Phila Pa 1976) 2015; 40:537.
  17. Bunnell WP. Outcome of spinal screening. Spine (Phila Pa 1976) 1993; 18:1572.
  18. 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; 15:535.
  19. Huang SC. Cut-off point of the Scoliometer in school scoliosis screening. Spine (Phila Pa 1976) 1997; 22:1985.
  20. Ascani E, Bartolozzi P, Logroscino CA, et al. Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine (Phila Pa 1976) 1986; 11:784.
  21. Weinstein SL, Zavala DC, Ponseti IV. Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Joint Surg Am 1981; 63:702.
  22. Weinstein SL. Idiopathic scoliosis. Natural history. Spine (Phila Pa 1976) 1986; 11:780.
  23. Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis 2006; 1:2.
  24. Screening for adolescent idiopathic scoliosis. Policy statement. US Preventive Services Task Force. JAMA 1993; 269:2664.
  25. Reamy BV, Slakey JB. Adolescent idiopathic scoliosis: review and current concepts. Am Fam Physician 2001; 64:111.
  26. Skaggs DL, Bassett GS. Adolescent idiopathic scoliosis: an update. Am Fam Physician 1996; 53:2327.
  27. Sponseller PD. Sizing up scoliosis. JAMA 2003; 289:608.
  28. Sanders JO, Khoury JG, Kishan S, et al. Predicting scoliosis progression from skeletal maturity: a simplified classification during adolescence. J Bone Joint Surg Am 2008; 90:540.
  29. Wang WW, Xia CW, Zhu F, et al. Correlation of Risser sign, radiographs of hand and wrist with the histological grade of iliac crest apophysis in girls with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2009; 34:1849.
  30. Scoliosis. In: Essentials of Musculoskeletal Care, 2nd ed, Greene WB (Ed), American Academy of Orthopedic Surgeons, Rosemont, IL 2001. p.696.
  31. Sponseller PD. Bone, joint, and muscle problems. In: Oski's Pediatrics: Principles and Practice, 4th ed, McMillan JA, Feigin RD, DeAngelis CD, Jones MD Jr (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.2488.
  32. American College of Radiology. ACR-SPR-SSR practice parameter for the performance of radiography for scoliosis in children. 2014. Available at: http://www.acr.org/Quality-Safety/Standards-Guidelines/Practice-Guidelines-by-Modality/Pediatric (Accessed on April 11, 2015).
  33. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013; 369:1512.
  34. Willers U, Normelli H, Aaro S, et al. Long-term results of Boston brace treatment on vertebral rotation in idiopathic scoliosis. Spine (Phila Pa 1976) 1993; 18:432.
  35. Carr WA, Moe JH, Winter RB, Lonstein JE. Treatment of idiopathic scoliosis in the Milwaukee brace. J Bone Joint Surg Am 1980; 62:599.
  36. Mellencamp DD, Blount WP, Anderson AJ. Milwaukee brace treatment of idiopathic scoliosis: late results. Clin Orthop Relat Res 1977; :47.
  37. Pehrsson K, Bake B, Larsson S, Nachemson A. Lung function in adult idiopathic scoliosis: a 20 year follow up. Thorax 1991; 46:474.
  38. Romano M, Minozzi S, Bettany-Saltikov J, et al. Exercises for adolescent idiopathic scoliosis. Cochrane Database Syst Rev 2012; 8:CD007837.
  39. Bylund P, Aaro S, Gottfries B, Jansson E. Is lateral electric surface stimulation an effective treatment for scoliosis? J Pediatr Orthop 1987; 7:298.
  40. Wong MS, Mak AF, Luk KD, et al. Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients. Prosthet Orthot Int 2001; 25:60.
  41. Idiopathic Scoliosis in Adolescents: Screening. June 2004. US Preventive Services Task Force. Available at: www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/idiopathic-scoliosis-in-adolescents-screening (Accessed on May 20, 2015).
  42. Winter RB, Lovell WW, Moe JH. Excessive thoracic lordosis and loss of pulmonary function in patients with idiopathic scoliosis. J Bone Joint Surg Am 1975; 57:972.
  43. Dickson RA, Weinstein SL. Bracing (and screening)--yes or no? J Bone Joint Surg Br 1999; 81:193.
  44. Roach JW. Adolescent idiopathic scoliosis. Orthop Clin North Am 1999; 30:353.
  45. Price CT, Scott DS, Reed FR Jr, et al. Nighttime bracing for adolescent idiopathic scoliosis with the Charleston Bending Brace: long-term follow-up. J Pediatr Orthop 1997; 17:703.
  46. Janicki JA, Poe-Kochert C, Armstrong DG, Thompson GH. A comparison of the thoracolumbosacral orthoses and providence orthosis in the treatment of adolescent idiopathic scoliosis: results using the new SRS inclusion and assessment criteria for bracing studies. J Pediatr Orthop 2007; 27:369.
  47. Lee CS, Hwang CJ, Kim DJ, et al. Effectiveness of the Charleston night-time bending brace in the treatment of adolescent idiopathic scoliosis. J Pediatr Orthop 2012; 32:368.
  48. Gammon SR, Mehlman CT, Chan W, et al. A comparison of thoracolumbosacral orthoses and SpineCor treatment of adolescent idiopathic scoliosis patients using the Scoliosis Research Society standardized criteria. J Pediatr Orthop 2010; 30:531.
  49. Green NE. Part-time bracing of adolescent idiopathic scoliosis. J Bone Joint Surg Am 1986; 68:738.
  50. Rowe DE, Bernstein SM, Riddick MF, et al. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am 1997; 79:664.
  51. Newton PO, Wenger DR, Yaszay B. Idiopathic scoliosis. In: Lovell and Winter's Pediatric Orthopaedics, 7th ed, Weinstein SL, Flynn JM (Eds), Lippincott Williams & Wilkins, Philadelphia 2014. p.629.
  52. DiRaimondo CV, Green NE. Brace-wear compliance in patients with adolescent idiopathic scoliosis. J Pediatr Orthop 1988; 8:143.
  53. Nicholson GP, Ferguson-Pell MW, Smith K, et al. The objective measurement of spinal orthosis use for the treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2003; 28:2243.
  54. Sanders JO, Newton PO, Browne RH, et al. Bracing for idiopathic scoliosis: how many patients require treatment to prevent one surgery? J Bone Joint Surg Am 2014; 96:649.
  55. Miller DJ, Franzone JM, Matsumoto H, et al. Electronic monitoring improves brace-wearing compliance in patients with adolescent idiopathic scoliosis: a randomized clinical trial. Spine (Phila Pa 1976) 2012; 37:717.
  56. Noonan KJ, Weinstein SL, Jacobson WC, Dolan LA. Use of the Milwaukee brace for progressive idiopathic scoliosis. J Bone Joint Surg Am 1996; 78:557.
  57. Li M, Wong MS, Luk KD, et al. Time-dependent response of scoliotic curvature to orthotic intervention: when should a radiograph be obtained after putting on or taking off a spinal orthosis? Spine (Phila Pa 1976) 2014; 39:1408.
  58. Screening for adolescent idiopathic scoliosis. Review article. US Preventive Services Task Force. JAMA 1993; 269:2667.
  59. Kahanovitz N, Snow B, Pinter I. The comparative results of psychologic testing in scoliosis patients treated with electrical stimulation or bracing. Spine (Phila Pa 1976) 1984; 9:442.
  60. Fällström K, Cochran T, Nachemson A. Long-term effects on personality development in patients with adolescent idiopathic scoliosis. Influence of type of treatment. Spine (Phila Pa 1976) 1986; 11:756.
  61. Debeer P, Van Den Eede E, Moens P. Scapular winging: an unusual complication of bracing in idiopathic scoliosis. Clin Orthop Relat Res 2007; 461:258.
  62. Aurori BF, Weierman RJ, Lowell HA, et al. Pseudarthrosis after spinal fusion for scoliosis. A comparison of autogeneic and allogeneic bone grafts. Clin Orthop Relat Res 1985; :153.
  63. Stasikelis PJ, Pugh LI, Allen BL Jr. Surgical corrections in scoliosis: a meta-analysis. J Pediatr Orthop B 1998; 7:111.
  64. Merola AA, Haher TR, Brkaric M, et al. A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument. Spine (Phila Pa 1976) 2002; 27:2046.
  65. Fabry G. Allograft versus autograft bone in idiopathic scoliosis surgery: a multivariate statistical analysis. J Pediatr Orthop 1991; 11:465.
  66. Jain A, Kebaish KM, Sponseller PD. Factors associated with use of bone morphogenetic protein during pediatric spinal fusion surgery: an analysis of 4817 patients. J Bone Joint Surg Am 2013; 95:1265.
  67. Niemeyer T, Freeman BJ, Grevitt MP, Webb JK. Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity. Eur Spine J 2000; 9:499.
  68. Sarwark JF. Idiopathic scoliosis: New instrumentation for surgical management. J Am Acad Orthop Surg 1994; 2:67.
  69. Gitelman Y, Lenke LG, Bridwell KH, et al. Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis. Spine (Phila Pa 1976) 2011; 36:1665.
  70. Geck MJ, Rinella A, Hawthorne D, et al. Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery: a comparison of two practices. Spine (Phila Pa 1976) 2009; 34:1942.
  71. Lonner BS, Auerbach JD, Estreicher M, et al. Video-assisted thoracoscopic spinal fusion compared with posterior spinal fusion with thoracic pedicle screws for thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am 2009; 91:398.
  72. Newton PO. Thoracoscopic anterior instrumentation for idiopathic scoliosis. Spine J 2009; 9:595.
  73. Hefti FL, McMaster MJ. The effect of the adolescent growth spurt on early posterior spinal fusion in infantile and juvenile idiopathic scoliosis. J Bone Joint Surg Br 1983; 65:247.
  74. Sanders JO, Herring JA, Browne RH. Posterior arthrodesis and instrumentation in the immature (Risser-grade-0) spine in idiopathic scoliosis. J Bone Joint Surg Am 1995; 77:39.
  75. Burton DC, Asher MA, Lai SM. Scoliosis correction maintenance in skeletally immature patients with idiopathic scoliosis. Is anterior fusion really necessary? Spine (Phila Pa 1976) 2000; 25:61.
  76. Yang B, Li H, Wang D, et al. Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery. PLoS One 2013; 8:e55436.
  77. Henry DA, Carless PA, Moxey AJ, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2011; :CD001886.
  78. Tzortzopoulou A, Cepeda MS, Schumann R, Carr DB. Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database Syst Rev 2008; :CD006883.
  79. Johnston CE 2nd, Happel LT Jr, Norris R, et al. Delayed paraplegia complicating sublaminar segmental spinal instrumentation. J Bone Joint Surg Am 1986; 68:556.
  80. Diab M, Smith AR, Kuklo TR, Spinal Deformity Study Group. Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2007; 32:2759.
  81. Schwartz DM, Auerbach JD, Dormans JP, et al. Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am 2007; 89:2440.
  82. Reames DL, Smith JS, Fu KM, et al. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine (Phila Pa 1976) 2011; 36:1484.
  83. Ramo BA, Richards BS. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: five-year update on a previously published cohort. Spine (Phila Pa 1976) 2012; 37:1211.
  84. Danielsson AJ, Nachemson AL. Radiologic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis: comparison of brace and surgical treatment with matching control group of straight individuals. Spine (Phila Pa 1976) 2001; 26:516.
  85. Rubery PT, Bradford DS. Athletic activity after spine surgery in children and adolescents: results of a survey. Spine (Phila Pa 1976) 2002; 27:423.
  86. Fabricant PD, Admoni S, Green DW, et al. Return to athletic activity after posterior spinal fusion for adolescent idiopathic scoliosis: analysis of independent predictors. J Pediatr Orthop 2012; 32:259.
  87. Thyssen JP, Menné T, Schalock PC, et al. Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery. Br J Dermatol 2011; 164:473.
  88. Shau DN, Bible JE, Gadomski SP, et al. Utility of Postoperative Radiographs for Pediatric Scoliosis: Association Between History and Physical Examination Findings and Radiographic Findings. J Bone Joint Surg Am 2014; 96:1127.
  89. 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; 289:559.
  90. Mayo NE, Goldberg MS, Poitras B, et al. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part III: Back pain. Spine (Phila Pa 1976) 1994; 19:1573.
  91. Dickson JH, Erwin WD, Rossi D. Harrington instrumentation and arthrodesis for idiopathic scoliosis. A twenty-one-year follow-up. J Bone Joint Surg Am 1990; 72:678.
  92. Collis DK, Ponseti IV. Long-term follow-up of patients with idiopathic scoliosis not treated surgically. J Bone Joint Surg Am 1969; 51:425.
  93. Andersen MO, Christensen SB, Thomsen K. Outcome at 10 years after treatment for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2006; 31:350.
  94. Haefeli M, Elfering A, Kilian R, et al. Nonoperative treatment for adolescent idiopathic scoliosis: a 10- to 60-year follow-up with special reference to health-related quality of life. Spine (Phila Pa 1976) 2006; 31:355.
  95. Cordover AM, Betz RR, Clements DH, Bosacco SJ. Natural history of adolescent thoracolumbar and lumbar idiopathic scoliosis into adulthood. J Spinal Disord 1997; 10:193.
  96. Goldberg MS, Mayo NE, Poitras B, et al. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part I: Description of the study. Spine (Phila Pa 1976) 1994; 19:1551.
  97. Grauers A, Topalis C, Möller H, et al. Prevalence of Back Problems in 1069 Adults With Idiopathic Scoliosis and 158 Adults Without Scoliosis. Spine (Phila Pa 1976) 2014.
  98. Payne WK 3rd, Ogilvie JW, Resnick MD, et al. Does scoliosis have a psychological impact and does gender make a difference? Spine (Phila Pa 1976) 1997; 22:1380.
  99. Akazawa T, Minami S, Kotani T, et al. Long-term clinical outcomes of surgery for adolescent idiopathic scoliosis 21 to 41 years later. Spine (Phila Pa 1976) 2012; 37:402.
  100. Lonstein JE. Scoliosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res 2006; 443:248.
  101. Betz RR, Bunnell WP, Lambrecht-Mulier E, MacEwen GD. Scoliosis and pregnancy. J Bone Joint Surg Am 1987; 69:90.
  102. Bunnell WP. The natural history of idiopathic scoliosis. Clin Orthop Relat Res 1988; :20.
  103. Visscher W, Lonstein JE, Hoffman DA, et al. Reproductive outcomes in scoliosis patients. Spine (Phila Pa 1976) 1988; 13:1096.
  104. Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine (Phila Pa 1976) 1992; 17:1091.