Management and Treatment of Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) represents the most common structural spinal deformity in otherwise healthy adolescents, characterised by a lateral curvature exceeding 10° and associated axial rotation. The management paradigm hinges on curve magnitude, skeletal maturity and risk of progression, balancing conservative measures against surgical intervention. Observation is reserved for mild curves with low progression risk, while rigid bracing aims to halt advancement during peak growth. Physiotherapeutic scoliosis-specific exercises complement orthotic treatment by promoting active postural correction, muscular symmetry and respiratory function. Surgical correction, typically by posterior spinal fusion with pedicle screw instrumentation, is indicated for curves exceeding 45–50° or those that progress despite bracing. Contemporary practice emphasises individualised care within multidisciplinary teams, integrating advancements in imaging, three-dimensional surgical planning and motion-preserving technologies. A nuanced understanding of growth dynamics, patient quality of life and long-term outcomes underpins decision making, guiding the selection and sequencing of intervention modalities to optimise spinal alignment, function and psychosocial well-being.

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Management and Treatment of Adolescent Idiopathic Scoliosis publication trend

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Technical terms

Cobb angle: The standard radiographic measure of coronal spinal curvature, defined by the intersection of lines drawn along the endplates of the most tilted vertebrae.

Bracing: Use of a rigid external orthosis designed to counteract spinal curvature progression by applying corrective forces during growth.

Thoracolumbosacral orthosis (TLSO): A custom-moulded spinal brace that encompasses the thoracic, lumbar and sacral regions to stabilise and correct scoliotic deformities.

Schroth physiotherapeutic scoliosis-specific exercises (PSSE): A regimen of posture-correcting, breathing-based exercises aiming to derotate, elongate and stabilise the scoliotic spine.

Risser grade: An assessment of skeletal maturity based on the ossification of the iliac apophysis, used to estimate remaining spinal growth.

References

1. Immediate vs Gradual Brace Weaning Protocols in Adolescent Idiopathic Scoliosis. JAMA Pediatrics (2024).
2. Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review. BMC Musculoskeletal Disorders (2020).
3. The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: A single-blind, randomized-controlled trial. PLOS ONE (2021).