Adolescent Idiopathic Scoliosis: trends, indications and efficacy of non-operative and operative treatments

During the past decade, several studies have demonstrated that the natural history of adolescent idiopathic scoliosis can be positively affected by orthopaedic treatment. Treatment options include observation, bracing and/or surgery. Observation is appropriate treatment for small curves, curves that are at low risk of progression and those with a natural history that is favourable at the completion of growth. Indications for brace treatment are a growing child presenting with a curve of 25–40° or a curve <25° with documented progression. Curves of 20–25° in patients with pronounced skeletal immaturity (Risser 0, Tanner 1 or 2) should also be treated. Expert opinion differs as to the efficacy of conservative approaches to scoliosis treatment. To date, there is no evidence in the published literature to prove that alternative forms of non-surgical treatment, such as chiropractic or osteopathic manipulation, acupuncture, exercise or other manual treatments are effective in controlling spinal deformities. Indications for the surgical treatment of spinal deformities are related to the natural history of the deformity and potential consequences for the patient in adult life. In general, surgery is performed in patients with remaining skeletal growth and presenting curves >45–50°. When treating patients with spinal deformities, either conservatively or surgically, it is particularly important to determine skeletal age to assess remaining growth. The purpose of this review is to provide information about the operative and non-operative treatment of adolescent idiopathic scoliosis. Indications for treatment, complications, scoliosis classification systems and skeletal age assessment are discussed.