Adolescent Idiopathic Scoliosis

Abstract

Background: Scoliosis refers to deviation of spine greater than 10 degrees in the coronal plane. Idiopathic Scoliosis is the most common spinal deformity that develops in otherwise healthy children. The sub types of scoliosis are based on the age of the child at presentation. Adolescent idiopathic scoliosis (AIS) by definition occurs in children over the age of 10 years until skeletal maturity.

Objective: The objective of this review is to outline the features of AIS to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.

Method: A thorough literature search was performed using available databases, including Pubmed and Embase, to cover important research published covering AIS.

Conclusion: AIS results in higher incidence of back pain and discontent with body image. Curves greater than 50 degrees in thoracic region and greater than 30 degrees in lumbar region progress at a rate of 0.5 to 1 degree per year into adulthood. Curves greater than 60 degrees can lead to pulmonary functional deficit. Therefore once the disease is recognized, effective treatment should be instituted to address the deformity and prevention of its long-term sequelae.

Keywords: Adolescent; deformity; scoliosis; spine.

Fig. (1)

Clinical appearance of an adolescent girl with a right thoracic curve.

Fig. (2)

This figure demonstrates Risser grading from zero to 5. Grading depends on the degree of bony fusion of the iliac apophysis. Grade zero signifies no ossification. Grade 5 signifies complete bony fusion.

Fig. (3)

Adams forward-bending test. Here a patient is viewed from behind and asked to bend forward until the spine is horizontal. Note the right side of the back appears higher than the left.

Fig. (4)

a Posterio-anterior standing radiograph showing right thoracic curve. b Lateral standing radiograph.

Fig. (5)

The Cobb method of measuring the degree of scoliosis. Choose the most tilted vertebrae above and below the apex of the curve. The angle between intersecting line drawn perpendicular to the superior endplate of the top vertebrae and the inferior endplate of the bottom verterbrae is the Cobb angle.

Fig. (6)

Bending radiographs performed here to assess the stiffness of the curve. The degree of correction is a measure of curve flexibility. This assists in planning the level of surgery required and is predictive of correction possibile with surgery.

Fig. (7)

Postoperative posterio-anterior and lateral radiographs demonstrating a satisfactory coronal plane correction (compare to pre-operative radiographs in Fig. (4)