Treatment of adolescent idiopathic scoliosis and evaluation of the adolescent patient

Adolescent idiopathic scoliosis (AIS) is a three-dimensional, multi-faceted deformity of the vertebral column. Although screening is mandated by several states, debate exists surrounding the efficacy or utility of in-school scoliosis screenings. Detailed history and physical examination are crucial to this diagnosis of exclusion. Assessment of curves has long been limited to static radiography; however, use of MRI may permit detection of associated spinal anomalies, while three-dimensional gait analysis may permit improved understanding of functional improvement in AIS patients before and after treatment. Nonoperative management includes bracing, which is a complex, yet important, component to treatment of AIS. The Bracing in Adolescents with Idiopathic Scoliosis Trial (BrAIST) and other studies have revealed the potential for halting curve progression and a positive dose-response relationship of bracing. Surgical management has focused on the mainstay of posterior spinal fusion with pedicle screw fixation and rod instrumentation, with new techniques under development that modify fusion and fixation or focus on different approaches altogether (i.e. vertebral body tethering). This article details evaluation and treatment of AIS, supplemented by a review of the historical progression of management, to equip readers with an appreciation for the complex nature of this pathology and its treatment.