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Adolescent idiopathic scoliosis
Background
Overview
Definition
Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine, characterized by a lateral curvature of the spine > 10 degrees, as measured via the Cobb angle. This condition typically presents in otherwise normal individuals aged 10-18 years with no identifiable cause.
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Pathophysiology
The pathophysiology of adolescent idiopathic scoliosis remains unclear, but it is believed to involve a combination of genetic, biomechanical, and neurological factors. Abnormalities in the growth of vertebrae and the surrounding soft tissues may lead to asymmetric spinal growth, resulting in curvature. Genetic factors have been implicated, with disease-causing and predisposing variants of SLC6A9 encoding the glycine transporter 1 (GLYT1) and susceptibility loci on chromosome 10q24.31, identified in some patients. Additionally, abnormalities in brain development and cerebral cortical thinning have been suggested as potential contributing factors.
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Epidemiology
The incidence of adolescent idiopathic scoliosis in the US is estimated at 522.5 per 100,000 person-years. The prevalence of adolescent idiopathic scoliosis globally is estimated at 0.47-5.2%.
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Risk factors
Risk factors for adolescent idiopathic scoliosis include a family history of adolescent idiopathic scoliosis, female sex, and vitamin D deficiency.
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Disease course
Clinically, adolescent idiopathic scoliosis may be asymptomatic or present with cosmetic concerns, back pain, or respiratory issues in severe cases.
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Prognosis and risk of recurrence
Some scoliosis curves remain stable, while others progress, particularly in patients with larger initial curves or those diagnosed at a younger age. The prognosis is generally favorable for mild curves, with many patients experiencing minimal impact on QoL. Curves with a Cobb angle of 10-19 degrees typically need only observation, while bracing and physical therapy can be considered for curves of 20-29 degrees and are recommended for those of 30-39 degrees. Significant curves (> 40 degrees) may require surgical intervention to prevent progression and associated complications.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of adolescent idiopathic scoliosis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2020), the American College of Radiology (ACR 2019), the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT 2018), and the U.S. Preventive Services Task Force (USPSTF 2018).
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Screening and diagnosis
Diagnostic investigations
Physical examination: as per SOSORT 2018 guidelines, take into account the measurement error for each method used for the assessment of scoliosis.
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Diagnostic imaging
Nonpharmacologic interventions
Bracing: as per AAFP 2020 guidelines, consider offering bracing to slow the progression of skeletal curvature in patients with adolescent idiopathic scoliosis.
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Physical therapy
Sports participation
Manual therapy
Correction of leg length discrepancy