Adolescent Idiopathic Scoliosis: Prevention [Clinical Review]

The descriptor "idiopathic" provides ample evidence that risk factors or prevention strategies for developing adolescent idiopathic scoliosis (AIS) are limited. There are many causes for scoliosis but fully 80% are classified as idiopathic (1). Investigation in this area is developing and several possible causative factors are currently being discussed in the literature. Among these, to name a few, are genetic influences (2), hormonal changes (3), age of mother at birth (4), platelets, connective tissue disorders, musculature disorders and dysfunction of the posture controlling system (5). Considering the lack of information relating to etiology, of greater clinical importance to the physician and patient is to identify risk factors which may lead to progression of the scoliotic curve. Significant advances have been published which allow the doctor to identify those patients who are in danger of progression, thereby avoiding unnecessary treatment in some and initiation of necessary treatment in others. The natural history of scoliosis reveals few scoliosis patients actually require treatment. In a 10-year follow-up study of 2700 students Karachalios et al found curves of less than 10° increased in 35.8% patients with an average increase of 8°. Surprisingly 14.9% of patients experienced decreased Cobb?s angle. None of these patients required treatment. In those with curves between 10° and 20°, 48.3% progressed between 5° and 14°. Overall 0.15% of the curvatures required bracing and 0.03% required surgery (6). These findings are similar to those found in other studies (7;8).

For the purpose of this paper only risk factors for progression will be discussed.