Adolescent idiopathic scoliosis: a comprehensive approach to aetiology, diagnostic assessment and treatment

Adolescent idiopathic scoliosis is the most common type of spinal deformity seen in the paediatric population. The deformity affects otherwise normal functioning teenagers with no underlying pathological condition, no neurological abnormalities and normal imaging of the neuraxis. It produces a cosmetic deformity occasionally associated with muscular back pain and respiratory compromise in severe degrees of deformity. The aetiology is likely multifactorial and the risk of curve progression depends on the age of the patient at initial presentation, amount of remaining spinal growth and initial size of the curvature. Patients should be assessed with a thorough clinical evaluation including radiographic and often magnetic resonance imaging. Observation is recommended in growing patients with small curves up to 20-25°. Bracing can stop or slow down curve progression in growing patients with curves up to 40°. Surgical treatment is indicated in the presence of a severe deformity which is producing pain or pulmonary symptoms and is associated with cosmetic dissatisfaction. Most commonly this is performed through a posterior spinal fusion with the use of instrumentation and bone graft. The aim of the surgery is to stabilize the spine, correct the deformity and prevent deterioration. This has to be performed safely minimizing the risks of neurological/vascular/visceral injury, infection or non-union with instrumentation failure.