Scoliosis: a review

Area of Science:

• Orthopaedic Surgery
• Developmental Biology
• Paediatric Medicine

Background:

• Scoliosis, a lateral spinal curvature, presents diagnostic and treatment challenges due to its varied forms, unknown etiology, and unpredictable progression.
• Despite extensive study since antiquity, significant controversies persist within orthopaedic surgery regarding scoliosis management.
• A 30-year review of a paediatric orthopaedic unit's experience aimed to elucidate the complexities of adolescent idiopathic scoliosis.

Purpose of the Study:

• To analyze the incidence, prevalence, extent, course, and outcomes of adolescent idiopathic scoliosis.
• To evaluate the efficacy of current treatment modalities, particularly non-operative interventions.
• To propose an alternative model for scoliosis pathogenesis based on developmental biology.

Main Methods:

• Prospective collection and examination of patient records over a 30-year period.
• Analysis of data from a school screening program to assess community prevalence.
• Review of existing literature and comparison with published studies on scoliosis.

Main Results:

• Slight spinal curvatures are common but typically not clinically significant; major deformities requiring surgery are rare (8 in 10,000 adolescent girls with Cobb angles ≥40 degrees).
• Non-operative treatments demonstrated no clear evidence of efficacy in altering the natural course or reducing the need for surgical intervention.
• The observed natural history of scoliosis in the study cohort did not align with established literature or prevailing etiological hypotheses.

Conclusions:

• Adolescent idiopathic scoliosis is less prevalent and severe than often assumed, with non-operative treatments lacking proven benefit.
• Current understanding of scoliosis etiology and natural history requires re-evaluation, suggesting a need for novel research directions.
• Advances in surgical techniques are noted, but fundamental questions regarding the cause and progression of scoliosis remain unresolved, making current management strategies provisional.