Current issues in the treatment of adolescent idiopathic scoliosis: a comprehensive narrative review

Abstract

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of unknown etiology that commonly affects adolescents, imposing significant socioeconomic burdens. Effective management necessitates a comprehensive approach that takes into account multiple factors, including growth potential and psychological issues. Despite significant advancements in AIS management, several questions regarding optimal treatment strategies persist. Recent technological advancements are transforming the treatment landscape, encompassing advancements in bracing, robotic-assisted deformity corrections, and other interventions. This review explores current issues debated in the literature concerning the treatment of AIS, focusing on contemporary high-level evidence (e.g., meta-analyses and randomized controlled trials). Furthermore, this review explores cutting-edge developments and future directions in AIS management, including the integration of artificial intelligence and augmented reality.

Keywords: Adolescent idiopathic scoliosis; Machine learning; Minimally invasive surgery; Navigation; Robotics.

Fig. 1

Different types of braces used in the treatment of adolescent idiopathic scoliosis. (A) Milwaukee brace. (B) Boston brace. (C) Charleston brace. (D) Hybrid brace.

Fig. 2

Direct vertebral rotation (DVR) maneuver during adolescent idiopathic scoliosis correction. (A) DVR on the apical vertebra. (B) DVR on lower-instrumented vertebra.

Fig. 3

(A–D) An illustrative case of adolescent idiopathic scoliosis with dysplastic pedicles surgically corrected using stereotactic navigation-assisted pedicle screw instrumentation.

Fig. 4

(A–C) An illustrative case of adolescent idiopathic scoliosis surgically corrected using minimally invasive surgical techniques. Written informed consent for the publication of this image was obtained from the patient. (Courtesy of Prof. Jae Hyuk Yang and Prof. Seung Woo Suh from Korea University).

Fig. 5

Illustrative cases of the two surgical strategies. (A) Low-density pedicle screw construct without lower instrumented vertebra direct vertebral rotation (LIV DVR). (B) High-density pedicle screw construct with LIV DVR.