Adolescent idiopathic scoliosis: diagnosis and management

Adolescent idiopathic scoliosis is the most common form of scoliosis, affecting approximately 2% to 4% of adolescents. The incidence of scoliosis is about the same in males and females; however, females have up to a 10-fold greater risk of curve progression. Although most youths with scoliosis will not develop clinical symptoms, scoliosis can progress to rib deformity and respiratory compromise, and can cause significant cosmetic problems and emotional distress for some patients. For decades, scoliosis screenings were a routine part of school physical examinations in adolescents. The U.S. Preventive Services Task Force and American Academy of Family Physicians recommend against routine scoliosis screening in asymptomatic adolescents, concluding that harm from screening outweighs the benefit because screenings expose many low-risk adolescents to unnecessary radiographs and referrals. In contrast, the Scoliosis Research Society, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, and Pediatric Orthopaedic Society of North America suggest that the potential benefit of detecting scoliosis early justifies screening programs, but greater care should be used in deciding which patients with positive screening results need further evaluation. The goal for primary care physicians is to identify patients who are at risk of developing problems from scoliosis, without overtesting or overreferring patients who are unlikely to have further problems. Physical examination with the Adam's forward bend test and a scoliometer measurement can guide judicious use of radiologic testing for Cobb angle measurement and orthopedic referrals. Treatment options include observation, braces, and surgery.