Scoliosis is defined as a lateral curvature of the spine that is usually accompanied by rotation (image 1). Scoliosis is not a diagnosis, but a description of a structural alteration that occurs in a variety of conditions. Progression of the curvature during periods of rapid growth may result in significant deformity, which may be accompanied by cardiopulmonary compromise.
The treatment and prognosis of adolescent idiopathic scoliosis will be reviewed here. The clinical features, diagnosis, and initial evaluation are discussed separately. (See "Adolescent idiopathic scoliosis: Clinical features, evaluation, and diagnosis".)
The goal of the treatment of adolescent idiopathic scoliosis (AIS) is a curve with a Cobb angle (image 2) of 40º or less at skeletal maturity. Curves with Cobb angles greater than 50º at skeletal maturity may progress approximately one degree per year after cessation of growth . Over 30 years, such curves may progress to >80º. Thoracic curves of this severity have been associated with restrictive lung disease and compromised pulmonary function. (See "Adolescent idiopathic scoliosis: Clinical features, evaluation, and diagnosis", section on 'Natural history'.)
Options for treatment include observation, bracing, and surgery, as discussed below [2-6]. There is a lack of high-quality evidence from randomized trials that physical therapy (scoliosis specific exercises), chiropractic treatment, electrical stimulation, or biofeedback is effective [7-9].
The choice of therapy depends upon the degree of curvature (as measured by the Cobb angle) and potential for further growth (which determines the risk for progression). Potential for further growth can be estimated by a combination of chronologic age, menarchal status in girls, skeletal maturity, and the Risser sign [10-12]. Skeletal growth is considered complete in girls two years postmenarche and in boys when daily shaving is needed. Girls are considered skeletally mature at Risser 4 and boys at Risser 5. Finally, the cessation of height gains is a concrete sign of the end of growth. (See "Adolescent idiopathic scoliosis: Clinical features, evaluation, and diagnosis", section on 'Risk for progression'.)