Adolescent idiopathic scoliosis

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2508 (Published 30 April 2013)
Cite this as: BMJ 2013;346:f2508

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  1. Farhaan Altaf, specialist registrar trauma and orthopaedics,
  2. Alexander Gibson, consultant spinal surgeon,
  3. Zaher Dannawi, spinal fellow,
  4. Hilali Noordeen, consultant spinal surgeon
  1. 1Spinal Surgery Unit, Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK
  1. Correspondence to: F Altaf farhaanaltaf{at}hotmail.com

Summary points

  • Scoliosis is a lateral curvature of the spine measuring >10° in the coronal plane

  • Several different types of scoliosis exist, and idiopathic scoliosis occurs in 0.5-3.0% of the paediatric population

  • Initial evaluation should involve a focused history and physical examination. The Adam’s forward bend test is particularly useful for detection

  • Factors predicting curve progression include maturity (age at diagnosis, menarchal status, and the amount of skeletal growth remaining), curve size, and position of the curve apex

  • Bracing is used to treat scoliosis in many European countries, but practice is divided in the UK and US, and elsewhere

  • Surgery is recommended in adolescents with a curve of a Cobb angle more than 45°-50°

Scoliosis is a three dimensional deformity of the spine defined as a lateral curvature of the spine in the coronal plane of more than 10°.1 It can be categorised into three major types—congenital, syndromic, and idiopathic. Congenital scoliosis refers to spinal deformity caused by abnormally formed vertebrae. Syndromic scoliosis is associated with a disorder of the neuromuscular, skeletal, or connective tissue systems; neurofibromatosis; or other important medical condition. Idiopathic scoliosis has no known cause and can be subdivided based on the age of onset—infantile idiopathic scoliosis includes patients aged 0-3 years, juvenile idiopathic scoliosis includes patients aged 4-10 years, and adolescent idiopathic scoliosis affects people aged >10 years.

Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity seen by primary care physicians, paediatricians, and spinal surgeons.2 This review is focused on AIS and reviews the diagnosis, management, and controversies surrounding this condition based on the available literature.

Sources and selection criteria

We searched Medline and the Cochrane Library using MeSH terms “adolescent idiopathic scoliosis”, and “scoliosis bracing”. We included systematic reviews, randomised controlled trials, and good quality prospective observational studies mainly from the past 15 years but did not …

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