Current concepts in the diagnosis and management of adolescent idiopathic scoliosis

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Abstract

Background

Adolescent Idiopathic Scoliosis (AIS) is a complex 3D structural disorder of the spine that has a significant impact on a person's physical and emotionalstatus. Thus, efforts have been made to identify the cause of the curvature and improve management outcomes.

Aim

This comprehensive review looks at the relevant literature surrounding the possible aetio-pathogenesis of AIS, its clinical features, investigations, surgicalmanagement options, and reported surgical outcomes in anterior spinal fusion, posterior spinal fusion or combined approach in the treatment of AIS.

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Most cited references 59

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Adolescent idiopathic scoliosis.

Stuart L. Weinstein, Lori Dolan, Jack Cheng … (2008)

Adolescent idiopathic scoliosis (AIS) affects 1-3% of children in the at-risk population of those aged 10-16 years. The aetiopathogensis of this disorder remains unknown, with misinformation about its natural history. Non-surgical treatments are aimed to reduce the number of operations by preventing curve progression. Although bracing and physiotherapy are common treatments in much of the world, their effectiveness has never been rigorously assessed. Technological advances have much improved the ability of surgeons to safely correct the deformity while maintaining sagittal and coronal balance. However, we do not have long-term results of these changing surgical treatments. Much has yet to be learned about the general health, quality of life, and self-image of both treated and untreated patients with AIS.

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Effects of bracing in adolescents with idiopathic scoliosis.

Stuart L. Weinstein, Lori Dolan, James G Wright … (2013)

The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. We conducted a multicenter study that included patients with typical indications for bracing due to their age, skeletal immaturity, and degree of scoliosis. Both a randomized cohort and a preference cohort were enrolled. Of 242 patients included in the analysis, 116 were randomly assigned to bracing or observation, and 126 chose between bracing and observation. Patients in the bracing group were instructed to wear the brace at least 18 hours per day. The primary outcomes were curve progression to 50 degrees or more (treatment failure) and skeletal maturity without this degree of curve progression (treatment success). The trial was stopped early owing to the efficacy of bracing. In an analysis that included both the randomized and preference cohorts, the rate of treatment success was 72% after bracing, as compared with 48% after observation (propensity-score-adjusted odds ratio for treatment success, 1.93; 95% confidence interval [CI], 1.08 to 3.46). In the intention-to-treat analysis, the rate of treatment success was 75% among patients randomly assigned to bracing, as compared with 42% among those randomly assigned to observation (odds ratio, 4.11; 95% CI, 1.85 to 9.16). There was a significant positive association between hours of brace wear and rate of treatment success (P<0.001). Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and others; BRAIST ClinicalTrials.gov number, NCT00448448.).

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Epidemiology of adolescent idiopathic scoliosis.

Markus Rafael Konieczny, Hüsseyin Senyurt, Rüdiger Krauspe (2013)

Adolescent idiopathic scoliosis is a common disease with an overall prevalence of 0.47-5.2 % in the current literature. The female to male ratio ranges from 1.5:1 to 3:1 and increases substantially with increasing age. In particular, the prevalence of curves with higher Cobb angles is substantially higher in girls than in boys: The female to male ratio rises from 1.4:1 in curves from 10° to 20° up to 7.2:1 in curves >40°. Curve pattern and prevalence of scoliosis is not only influenced by gender, but also by genetic factors and age of onset. These data obtained from school screening programs have to be interpreted with caution, since methods and cohorts of the different studies are not comparable as age groups of the cohorts and diagnostic criteria differ substantially. We do need data from studies with clear standards of diagnostic criteria and study protocols that are comparable to each other.

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Author and article information

Contributors

Andrew James Bowey: Andrew.Bowey@nuth.nhs.uk

Journal

Journal ID (nlm-ta): Childs Nerv Syst

Journal ID (iso-abbrev): Childs Nerv Syst

Title: Child's Nervous System

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0256-7040

ISSN (Electronic): 1433-0350

Publication date (Electronic): 21 April 2020

Publication date PMC-release: 21 April 2020

Publication date (Print): 2020

Volume: 36

Issue: 6

Pages: 1111-1119

Affiliations

[1 ]GRID grid.459561.a, ISNI 0000 0004 4904 7256, Department of Orthopaedic Spine Surgery, , Great North Children’s Hospital, ; Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP England

[2 ]GRID grid.1006.7, ISNI 0000 0001 0462 7212, Newcastle University, ; Newcastle upon Tyne, UK

Article

Publisher ID: 4608

DOI: 10.1007/s00381-020-04608-4

PMC ID: 7250959

PubMed ID: 32314025

SO-VID: 21241bb7-a76c-473c-a05e-a1f7f1ed8c0a

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 30 October 2019

Date accepted : 2 April 2020

Funding

Funded by: Newcastle University

Custom metadata

ScienceOpen disciplines: Neurology

Keywords: adolescent idiopathic scoliosis,current concepts,spinal fusion,aetio-pathogenesis

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ScienceOpen disciplines: Neurology

Keywords: adolescent idiopathic scoliosis, current concepts, spinal fusion, aetio-pathogenesis

Current concepts in the diagnosis and management of adolescent idiopathic scoliosis

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Abstract

Background

Aim

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Karger: Neurology and Neuroscience

Most cited references 59

Adolescent idiopathic scoliosis.

Effects of bracing in adolescents with idiopathic scoliosis.

Epidemiology of adolescent idiopathic scoliosis.

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