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Adolescent idiopathic scoliosis

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A Correction to this article was published on 15 October 2015

Abstract

Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle — a measure of spinal curvature — of ≥10°. AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.

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Figure 1: Measuring the Cobb angle.
Figure 2: Classification of scoliosis on the basis of the location of the spinal curve.
Figure 3: Global prevalence of AIS.
Figure 4: The cascade concept of AIS pathogenesis.
Figure 5: A proposed model of the aetiopathogenesis of AIS.
Figure 6: Summary of the morphological changes in the central nervous system involved in AIS.
Figure 7: Influence of shear loads on the spine.
Figure 8: Scoliosis screening tests.
Figure 9: The Hong Kong scoliosis screening protocol.
Figure 10: A patient with AIS treated with rigid bracing.
Figure 11: Spinal surgery for the treatment of AIS.
Figure 12: Potential role of early development in AIS.

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Acknowledgements

The authors thank the following people for their help during the preparation of the manuscript: D.Y.T. Fong (School of Nursing, University of Hong Kong, Hong Kong); J.P.Y. Cheung (Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong); P.H. Dangerfield (University of Liverpool and Staffordshire University, UK); A. Moulton (Sherwood Forest Hospitals NHS Foundation Trust, King's Mil Hospital, Mansfield, Nottinghamshire, UK); L. Shi (Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong); S.C.N. Hui (Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong); E.L.S. Tam (Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong); T.P. Lam (Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong); W.W. Chau (Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong); and D. Colo (Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands).

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong

    Jack C. Cheng

  2. Department of Orthopaedics and Traumatology, Joint Scoliosis Research Centre of The Chinese University of Hong Kong and Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong

    Jack C. Cheng

  3. Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    René M. Castelein

  4. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong

    Winnie C. Chu

  5. Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Aina J. Danielsson

  6. Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden

    Aina J. Danielsson

  7. Departments of Orthopaedic Surgery Neurology and Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA

    Matthew B. Dobbs

  8. Trauma and Orthopaedic Department, Tzaneio General Hospital of Piraeus, Athens, Greece

    Theodoros B. Grivas

  9. Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA

    Christina A. Gurnett

  10. Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong

    Keith D. Luk

  11. Viscogliosi Laboratory in Molecular Genetics of Musculoskeletal Diseases, Sainte-Justine University Hospital Research Center, Montreal, Quebéc, Canada

    Alain Moreau

  12. Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, Quebéc, Canada

    Alain Moreau

  13. Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebéc, Canada

    Alain Moreau

  14. Department of Orthopedic Surgery, University of California, San Diego, California, USA

    Peter O. Newton

  15. Rady Children's Hospital, San Diego, California, USA

    Peter O. Newton

  16. Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA

    Ian A. Stokes

  17. Department of Orthopedic Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA

    Stuart L. Weinstein

  18. Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust — Queen's Medical Centre Campus, Nottingham, UK

    R. Geoffrey Burwell

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  1. Jack C. Cheng
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Contributions

Introduction (T.B.G.); Epidemiology (K.D.L.); Mechanisms/pathophysiology (R.G.B., J.C.C., M.B.D., C.A.G., W.C.C., R.M.C., A.M. and I.A.S.); Diagnosis, screening and prevention (K.D.L.); Management (S.L.W. and P.O.N.); Quality of life (A.J.D.); Outlook (R.G.B. and J.C.C.); Overview of Primer (J.C.C.).

Corresponding author

Correspondence to Jack C. Cheng.

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Competing interests

A.M. declares research grants from Paradigm Spine LLC (New York City, New York, USA), two patent applications on behalf of Sainte-Justine University Hospital and nine issued patents owned by Centre hospitalier universitaire Sainte-Justine, which has signed a licensing agreement with Paradigm Spine LLC. I.A.S. declares a consulting agreement with K Spine Inc. (Minnetonga, Minnesota, USA). P.O.N. declares consulting and royalty agreements with DePuy Synthes Spine regarding posterior spinal implant systems. He holds patents on anterior and posterior spinal instruments and implants for spinal fusion, as well as implants for spinal growth modulation from DePuy Synthes through the Setting Scoliosis Straight Foundation/Harms Study Group. All other authors declare no conflict of financial interest.

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Cheng, J., Castelein, R., Chu, W. et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers 1, 15030 (2015). https://doi.org/10.1038/nrdp.2015.30

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