Adolescent idiopathic scoliosis (AIS) is a sideways curvature of the spine that emerges during the growth spurt just before puberty, affecting those between 10 and 18 years old. The term “idiopathic” means its underlying cause is unknown and not the result of any specific action by the adolescent or their parents. As the most common form of scoliosis, its development and progression can vary significantly from person to person. The condition involves a three-dimensional change in the spine.
Identifying the Signs
The initial signs of scoliosis are often subtle and visual. Common indicators include a visible difference in shoulder height, an uneven waistline, or the prominence of one shoulder blade sticking out more than its counterpart. Sometimes, the head may not appear centered over the pelvis, or one hip may sit higher, creating an overall asymmetrical posture.
A standard clinical screening method is the Adam’s forward bend test. During this test, the individual bends forward at the waist with their arms hanging freely. This position can reveal asymmetries in the back, such as a hump on one side of the rib cage, which indicates potential spinal rotation associated with scoliosis. This simple test helps determine if further evaluation is needed.
If the initial screening suggests scoliosis, a physician may use a scoliometer to measure the angle of trunk rotation. For a definitive diagnosis, standing X-rays of the entire spine are taken. These images allow a doctor to measure the severity of the curve using the Cobb angle method. The Cobb angle is a measurement in degrees that serves as the standard for diagnosing the condition and guiding treatment decisions.
Understanding the Condition’s Progression
Once a diagnosis of AIS is confirmed, the primary concern becomes whether the curve will worsen. The two most significant factors for predicting progression are the magnitude of the curve at diagnosis and the patient’s skeletal maturity. Curves that are larger to begin with and a patient’s remaining growth potential both indicate a higher chance of the curve increasing over time.
Gender also plays a role in the progression of scoliosis. While small curves occur with nearly equal frequency in males and females, females are up to ten times more likely to experience curve progression that requires medical intervention.
A physician determines a patient’s skeletal maturity by assessing physical development and using radiological markers. One common method is the Risser sign, which evaluates bone development on a pelvic X-ray, grading it on a scale from 0 to 5. A lower Risser stage indicates significant growth remaining and a higher risk that an existing curve will progress. The timing of peak growth velocity is also a period of high risk for curve worsening.
Management and Treatment Approaches
The management of AIS is tailored to the individual, determined by the severity of the curve and the amount of growth the adolescent has remaining. For mild curves, measured at less than 25 degrees, the standard approach is observation. This involves regular check-ups and periodic X-rays to monitor the spine for any signs of progression as the child grows.
For adolescents who are still growing and have moderate curves between 25 and 45 degrees, bracing is often recommended. The goal of a brace is not to correct the curve but to halt its progression during the remaining years of skeletal growth. Braces are custom-fitted and worn for a prescribed number of hours each day. Consistent adherence to the wearing schedule is necessary for the brace to be effective.
Surgical intervention is reserved for severe cases of scoliosis. This option is considered when a curve measures 45 to 50 degrees or more, or if a moderate curve continues to progress despite bracing. The most common procedure is a spinal fusion, where vertebrae in the curved section are fused into a single, solid bone. This procedure corrects a significant portion of the deformity and prevents it from worsening.
Life Beyond Diagnosis
The long-term outlook for most individuals diagnosed with AIS is positive. The majority, whether they receive treatment or not, go on to lead full and active lives. Participation in sports is encouraged, as maintaining physical fitness is beneficial for spinal health. Even after bracing or surgery, most patients can return to their previous activities.
Concerns about chronic back pain are common, but AIS does not automatically lead to significant pain issues in adulthood. Individuals with moderate curves in their lower back may have a slightly higher incidence of manageable back pain. For those who undergo spinal fusion, the surgery is successful at preventing the severe deformity that could lead to more serious health issues, such as respiratory problems.
Living with scoliosis also has a cosmetic component that can affect self-esteem, particularly during the adolescent years. The visible asymmetries of the condition or wearing a brace can be challenging. Modern treatments and supportive care can help manage these aspects. With proper monitoring and treatment, individuals can expect excellent long-term outcomes.