Scoliosis: Classification and Treatment

Adolescent idiopathic scoliosis (AIS) is defined by the presence of a spinal curvature of unknown etiology in a child between 10 and 18 years old. The etiology is unknown; however, it is thought to be related to a combination of genetic predisposition and mechanical factors that lead to curve development. Early management of AIS consists of bracing in curves over 25°. Bracing can halt curve progression but rarely leads to curve correction. Curves that do progress beyond 50° can be treated with surgery. Modern surgical techniques involve posterior-based pedicle screw instrumentation and fusion. Included fusion levels are based on several criteria, but in general, the shortest construct that will adequately correct the curve and limit chances of progression is optimal. Complications from corrective spinal surgery are uncommon but can be devastating. Patients and caregivers must be counseled on the natural history of AIS as well as the risks and benefits of treatment prior to receiving treatment.