Adolescent idiopathic scoliosis: radiologic decision-making

Adolescent onset of severe idiopathic scoliosis has traditionally been evaluated using standing posteroanterior radiographs of the full spine to assess lateral curvature with the Cobb method. The most tilted vertebral bodies above and below the apex of the spinal curve are used to create intersecting lines that give the curve degree. This definition is controversial, and patients do not exhibit clinically significant respiratory symptoms with idiopathic scoliosis until their curves are 60 to 100 degrees. There is no difference in the prevalence of back pain or mortality between patients with untreated adolescent idiopathic scoliosis and the general population. Therefore, many patients referred to physicians for evaluation of scoliosis do not need radiographic evaluation, back examinations, or treatment. Consensus recommendations for population screening, evaluation, and treatment of this disorder by medical organizations vary widely. Recent studies cast doubt on the clinical value of school-based screening programs.