Adolescent Idiopathic Scoliosis: Common Questions and Answers

 

Adolescent idiopathic scoliosis affects 1% to 3% of U.S. adolescents. It is defined by a lateral curvature of the spine (Cobb angle) of at least 10 degrees in the absence of underlying congenital or neuromuscular abnormalities. Adolescent idiopathic scoliosis may be detected via the forward bend test and should be confirmed with scoliometer measurement. Mild scoliosis is usually asymptomatic; it may contribute to musculoskeletal back pain, but there is no evidence that it causes disability or functional impairment. Patients with severe scoliosis (Cobb angle of 40 degrees or more) may have physical pain, cosmetic deformity, psychosocial distress, or, rarely, pulmonary disorders. Several studies have shown modest benefit from bracing and scoliosis-specific physical therapy to limit progression in mild to moderate scoliosis, but there were no effects on quality of life. Because no high-quality studies have proven that surgery is superior to bracing or observation, it should be reserved for severe cases. There is little evidence that treatments improve patient-oriented outcomes. The U.S. Preventive Services Task Force and the American Academy of Family Physicians found insufficient evidence to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents 10 to 18 years of age.

Adolescent idiopathic scoliosis is a lateral curvature of the spine (i.e., the Cobb angle) of 10 degrees or more that affects adolescents 10 to 18 years of age. It is the most common form of scoliosis and is distinguished from other types of scoliosis by the absence of underlying congenital or neuromuscular abnormalities. Approximately 1% to 3% of adolescents in the United States are affected.1 The incidence is similar between males and females. However, females are 10 times more likely to progress to Cobb angles of 30 degrees or more.1,2 Genetic factors are thought to contribute to the development of scoliosis, but inheritance patterns are variable, and no single mode of genetic transmission has been identified.2 There is no role for genetic testing in the screening and management of adolescent idiopathic scoliosis.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComment

The U.S. Preventive Services Task Force and the American Academy of Family Physicians concluded that evidence is insufficient to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in adolescents 10 to 18 years of age.2,3

C

Insufficient evidence that screening improves patient-oriented outcomes

A scoliometer measurement of 5 degrees or more requires radiologic evaluation for Cobb angle measurement, especially in overweight or obese patients.6,1214

C

Expert opinion and consensus guidelines in the absence of scoliosis screening clinical trials

Bracing and scoliosis-specific physical therapy may be effective for slowing progression of skeletal curvature.18,19,21

C

Limited number of studies with disease-oriented outcomes


A = consistent, good-quality, patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComment

The U.S. Preventive Services Task Force and the American Academy of Family Physicians concluded that evidence is insufficient to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in adolescents 10 to 18 years of age.2,3

C

Insufficient evidence that screening improves patient-oriented outcomes

A scoliometer measurement of 5 degrees or more requires radiologic evaluation for Cobb angle measurement, especially in overweight or obese patients.6,1214

C

Expert opinion and consensus guidelines in the absence of scoliosis screening clinical trials

Bracing and scoliosis-specific physical therapy may be effective for slowing progression of skeletal curvature.18,19,21

C

Limited number of studies with disease-oriented outcomes


A = consistent, good-quality, patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Authors

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ANGELA L. KUZNIA, MD, MPH, is an assistant professor of family medicine at the University of Michigan Medical School, Ann Arbor....

ANITA K. HERNANDEZ, MD, is an assistant professor of family medicine at the University of Michigan Medical School.

LYDIA U. LEE, MD, is a clinical lecturer in the Department of Family Medicine at the University of Michigan Medical School.

Address correspondence to Angela L. Kuznia, MD, MPH, University of Michigan Medical School, 300 N. Ingalls St. NI4C06, Ann Arbor, MI 48109 (email: akuznia@med.umich.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

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18. Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev. 2015;(6):CD006850.

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21. Monticone M, Ambrosini E, Cazzaniga D, et al. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J. 2014;23(6):1204–1214.

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23. Danielsson AJ, Hasserius R, Ohlin A, et al. Health-related quality of life in untreated versus brace-treated patients with adolescent idiopathic scoliosis: a long-term follow-up. Spine (Phila Pa 1976). 2010;35(2):199–205.

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