Weinstein and colleagues reviewed what is known about the cause, natural history and treatment of adolescent idiopathic scoliosis, and where the evidence falls short.
Lancet Seminar: narrative review of etiology, natural history, nonoperative care and surgery for AIS.
Methods
Scope
Lancet Seminar on adolescent idiopathic scoliosis
Topics
Etiopathogenesis and genetics
Natural history and curve progression
Bracing and physiotherapy
Surgery
Long‑term quality of life
Key Points
Bracing and physiotherapy are widely used, but the authors found that neither had been rigorously tested for effectiveness.
In a cited table, progression risk depended on curve size and age at detection: a curve over 40° progressed in 100% at age 10 to 12 and 70% at age 16, vs 0% for a curve under 19° at 16.
In a cited meta‑analysis of twin studies, AIS concordance was 73% in monozygotic vs 36% in dizygotic twins.
In Rahman and colleagues' cited series of 34 patients with temperature‑monitored braces, curves progressed in 11% of highly compliant patients vs 56% of less compliant ones.
Surgery rates after TLSO bracing ranged from 7% to 43% across 14 published series.
About a third of untreated patients felt their curve had limited their life, for example through trouble buying clothes, reduced physical ability or self‑consciousness.
Board pearl
The generally agreed surgical threshold in adolescents is a primary curve with a Cobb angle above 45°.
Authors' conclusion
Much has yet to be learned about the general health, quality of life, and self-image of both treated and untreated patients with AIS.
Weinstein and colleagues reviewed what is known about the cause, natural history and treatment of adolescent idiopathic scoliosis, and where the evidence falls short.
Lancet Seminar: narrative review of etiology, natural history, nonoperative care and surgery for AIS.
Methods
Scope
Lancet Seminar on adolescent idiopathic scoliosis
Topics
Etiopathogenesis and genetics
Natural history and curve progression
Bracing and physiotherapy
Surgery
Long‑term quality of life
Key Points
Bracing and physiotherapy are widely used, but the authors found that neither had been rigorously tested for effectiveness.
In a cited table, progression risk depended on curve size and age at detection: a curve over 40° progressed in 100% at age 10 to 12 and 70% at age 16, vs 0% for a curve under 19° at 16.
In a cited meta‑analysis of twin studies, AIS concordance was 73% in monozygotic vs 36% in dizygotic twins.
In Rahman and colleagues' cited series of 34 patients with temperature‑monitored braces, curves progressed in 11% of highly compliant patients vs 56% of less compliant ones.
Surgery rates after TLSO bracing ranged from 7% to 43% across 14 published series.
About a third of untreated patients felt their curve had limited their life, for example through trouble buying clothes, reduced physical ability or self‑consciousness.
Board pearl
The generally agreed surgical threshold in adolescents is a primary curve with a Cobb angle above 45°.
Authors' conclusion
Much has yet to be learned about the general health, quality of life, and self-image of both treated and untreated patients with AIS.