Adolescent Idiopathic Scoliosis

Introduction – What is it?

The term “idiopathic scoliosis” describes an abnormal curvature of the spine (for brevity, referred to as the spine or S.S.), but this does not mean that every curvature of the spine is scoliosis. According to the definition of the Scoliosis Research Society (SRS), scoliosis is a curvature of the spine greater than 11 degrees, accompanied by vertebral rotation. Scoliosis can be caused by congenital, developmental, or degenerative factors, but the majority of cases have no known cause and are classified as idiopathic scoliosis.

It most commonly appears in the thoracic region of the spine, at the thoracolumbar junction (between the thoracic and lumbar spine), or, less frequently, solely in the lumbar region. The curvature usually takes the shape of a “C” or two consecutive curves forming an “S” shape.

The Most Common Types of Scoliosis:

Congenital scoliosis: Caused by an inborn malformation of the vertebrae and is present from infancy.
Neuromuscular scoliosis: Results from muscle or nerve disorders that prevent the muscles from maintaining spinal alignment. It is common in children with conditions such as muscular dystrophy or cerebral palsy.
Degenerative scoliosis (adult scoliosis): Develops later in life due to spinal degeneration or arthritis of the vertebral joints and intervertebral discs.
Idiopathic or adolescent scoliosis: The most common type, appearing mainly in adolescence and progressing during the adolescent growth spurt.

Idiopathic Scoliosis

Idiopathic scoliosis is the most frequent type of scoliosis, appearing mainly during adolescence. The term “idiopathic” means that its cause is unknown, though it often runs in families, suggesting a hereditary component. In the U.S., it is estimated that approximately half a million teenagers have scoliosis, though no similar statistics exist for Greece.

Idiopathic scoliosis is classified based on the age of onset:

Infantile scoliosis: 0-3 years old
Juvenile scoliosis: 3-9 years old
Adolescent scoliosis: 9-18 years old (80% of all idiopathic scoliosis cases)

The risk of scoliosis progression increases during puberty, especially during the peak growth phase. This phase occurs at around 11 years of age in girls and 13 years in boys. Severe curvature requiring treatment is eight times more common in girls than in boys. However, most cases do not require any treatment.

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Diagnosis and Symptoms

Idiopathic scoliosis (IS) causes spinal deformity but not pain. Patients may experience back pain (e.g., lower back pain), similar to their peers, but scoliosis itself does not increase the likelihood of back pain. If a child has both scoliosis and pain, another underlying condition, such as a spinal tumor, should be considered.

Visible signs of scoliosis:

One shoulder is higher than the other
A more prominent shoulder blade on one side
A rib prominence or uneven rib height
One hip appears higher or more pronounced
Asymmetry of the waist

Scoliosis is often first identified by a pediatrician or school nurse. The most common screening test is Adam’s forward bend test, in which the student bends forward with straight legs and arms hanging down while the examiner observes the back from behind. This position reveals spinal asymmetry. If scoliosis is suspected, an X-ray is taken to confirm the diagnosis and measure the curvature in degrees using the Cobb angle method (accurate within 3-5 degrees).

An MRI is required in rare cases, such as when:

The diagnosis includes neurological symptoms (e.g., increased reflexes)
The scoliosis is left-sided (most idiopathic cases are right-sided)
Treatment is planned for a young child

Treatment Options

Observation

Curvatures smaller than 10 degrees are considered spinal asymmetry, not scoliosis, and generally require no follow-up unless the child is very young. Curvatures between 10-20 degrees are monitored every 4-6 months to check for progression. A curvature increase of at least 5 degrees is considered progression. If the increase is greater than 5 degrees and the child is still growing, a brace is recommended for curves over 20 degrees.

Bracing

A brace prevents progression but does not correct or “cure” scoliosis. Despite wearing a brace, about 25% of cases will still progress. Braces are used only during the period of maximum growth and are not necessary after skeletal maturity. The goal is to enter adulthood with a curvature of less than 50 degrees since curves greater than this may continue to worsen in adulthood.

Common types of braces include:

Thoracolumbosacral orthosis (TLSO): Custom-molded to the body, worn under clothing, and worn 16-21 hours per day.
Charleston Bending Brace: A nighttime brace that overcorrects the curve while the child sleeps, suitable for mild single thoracic curves.

Braces are recommended for girls aged 11-13 years and boys 12-14 years. If a child has a 30-degree curve but is nearly skeletally mature, bracing is unnecessary since progression is unlikely.

Scientific studies strongly support bracing. The BrAIST study (2013, New England Journal of Medicine) confirmed its effectiveness and helped refine usage guidelines.

Surgery – Spinal Fusion

Surgery is recommended when:

The curvature is greater than 40 degrees and worsening despite bracing.
The curvature is greater than 50 degrees after skeletal maturity, as it will likely worsen in adulthood.

Spinal fusion stabilizes the spine by fusing the affected vertebrae together, stopping the curve from worsening. Metal rods and screws help correct the deformity for a better aesthetic result.

For curves over 70 degrees, surgery is medically necessary to prevent compression of the heart and lungs. For curves between 40-70 degrees, surgery is primarily for cosmetic/aesthetic reasons.

Χειρουργός Σπονδυλικής Στήλης

Ο Χειρουργός Σπονδυλικής Στήλης/ Σκολίωσης Δρ. Ηλίας Χαρ. Παπαδόπουλος γεννήθηκε και μεγάλωσε στην Αθήνα. Αποφοίτησε με Άριστα από την Ιατρική Σχολή Αθηνών το 1994 και στη συνέχεια ειδικεύτηκε στην ορθοπαιδική, στην Α’ Ορθοπαιδική Κλινική του Πανεπιστημίου Αθηνών.