Laboratory Studies

Laboratory workup for patients with scoliosis consists primarily of preoperative testing. Most, if not all, patients undergo preoperative assessment of hemoglobin and hematocrit levels. Autologous blood predonation is also a common practice.

Radiography

Multiple authors have cited the value of bending radiographs, including those over a fulcrum.^[63]Klepps and Lenke et al found that thoracic fulcrum bending radiographs worked best for them when dealing with isolated main thoracic curves.^[64]

After the publication of the King classification in the early 1980s, the thoracic curve patterns found in adolescent idiopathic scoliosis (see the images below) were commonly classified according to this system.^[65]Subsequently, significant questions were raised regarding its reliability and reproducibility.^{[66, 67]}In addition, it was noted that the King classification alone (in its original form) does not allow comprehensive curve classification (eg, lumbar and thoracolumbar curve patterns).^[68] Many now regard the King classification as primarily of historical interest. The Lenke classification has become more commonly used for adolescent idiopathic scoliosis.^[69]

Mild juvenile scoliosis.

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Anteroposterior (AP) radiograph shows mild adolescent scoliosis.

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Lateral view of mild adolescent scoliosis.

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Moderate scoliosis.

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Multiple authors have analyzed the ability of orthopedic surgeons to reliably measure scoliosis radiographs. Morrissy et al used 50 radiographs and four examiners (two experienced orthopedic surgeons, one fellow, one senior resident) to study their ability to make Cobb angle measurements. With the examiners choosing end vertebrae and measuring scoliotic curves accordingly, intraobserver variability was 4.9°.^[70]

Carman et al used eight scoliosis radiographs measured by five examiners (four orthopedic surgeons, one physical therapist) to evaluate interobserver and intraobserver variation. They found that a 10° measurement difference is necessary before there is a 95% confidence level that one Cobb angle measurement is truly different from another.^[71]

Magnetic resonance imaging

Magnetic resonance imaging (MRI) has been suggested to be primarily indicated in patients with idiopathic scoliosis with unusual complaints such as severe unexplained headaches and when clinical findings such as ataxia or cavus feet are present.^[72]Routine MRI evaluation of all patients with adolescent idiopathic scoliosis is not recommended.^[73]

Ultrasonography

Ultrasonography (US) is increasingly being considered as a radiation-free imaging option in adolescents with idiopathic scoliosis.^{[74, 75]}

Other Tests

Pulmonary function studies have been used extensively in the evaluation of patients with idiopathic scoliosis.^{[7, 76, 77, 78]}In general, patients whose scoliosis surgery does not involve disruption of their chest wall can be expected to experience improved postoperative pulmonary function.^{[79, 58]}Other authors have suggested that an impairment in respiratory mechanics may persist after successful scoliosis surgery.^[80]Preoperative pulmonary function testing is of questionable value in patients with moderate deformity (average Cobb angle, 48°), as most of these patients can be expected to have normal or only mildly abnormal results.^[81]

Efforts at screening for scoliosis (most often in school populations) have met with mixed success. A 2-year evaluation of more than 80,000 Greek 9- to 14-year-old students screened by their schools with the Adams forward-bending test was conducted by Soucacos et al. Overall, they found school screening to be simple and effective. These authors found that they identified 181 new children with scoliosis requiring treatment (11 surgically, 170 with bracing).^[82]

Peak height velocity has been studied extensively as a predictor of curve progression.^[83]

A small study found that computerized photogrammetry, a novel method for nonradiographic evaluation, exhibited equivalent scoliosis angle measurements in 16 patients compared with the traditional Cobb radiographic method. Although more studies are needed to assess this tool, it may have potential for use as a coadjuvant tool in serial monitoring of scoliosis treatment.^[84]

Histologic Findings

Scoliosis is clearly a disease that is strongly influenced by, if not completely rooted in, spinal growth. It has even been referred to by some as "an unsynchronized growth."^[85]

Hsu et al from Vanderbilt studied muscle biopsies from 27 patients with idiopathic scoliosis who were undergoing posterior spinal fusion. Specimens were obtained from the paraspinal musculature of both the convex and concave side in all patients. All patients had thoracic curves in the range of 37-81°.^[86]

In this study, 68% of the patients demonstrated abnormalities in muscle fiber distribution. The abnormalities were similar on the convex and concave sides, the most notable being a reversal of the normal type 2 fiber ratio, so that type 2A fibers predominated over type 2B fibers in the study subjects. These changes are similar to those seen in endurance training and might be due to the extra work of trying to maintain posture in the setting of scoliosis.^[86]

Treatment & Management

Asher MA, Burton DC. A concept of idiopathic scoliosis deformities as imperfect torsion(s). Clin Orthop Relat Res. 1999 Jul. (364):11-25. [QxMD MEDLINE Link].
Charles YP, Diméglio A, Marcoul M, Bourgin JF, Marcoul A, Bozonnat MC. Influence of idiopathic scoliosis on three-dimensional thoracic growth. Spine (Phila Pa 1976). 2008 May 15. 33 (11):1209-18. [QxMD MEDLINE Link].
Lonstein JE. Idiopathic scoliosis. Lonstein JE, Bradford DS, Winter RB, Ogilvie J, eds. Moe's Textbook of Scoliosis and Other Spinal Deformities. 3rd ed. Philadelphia: WB Saunders; 1995. 219-56.
Helenius I, Remes V, Lamberg T, Schlenzka D, Poussa M. Long-term health-related quality of life after surgery for adolescent idiopathic scoliosis and spondylolisthesis. J Bone Joint Surg Am. 2008 Jun. 90(6):1231-9. [QxMD MEDLINE Link].
Clement JL, Chau E, Kimkpe C, Vallade MJ. Restoration of thoracic kyphosis by posterior instrumentation in adolescent idiopathic scoliosis: comparative radiographic analysis of two methods of reduction. Spine (Phila Pa 1976). 2008 Jun 15. 33 (14):1579-87. [QxMD MEDLINE Link].
Winter RB. The idiopathic double thoracic curve pattern. Its recognition and surgical management. Spine (Phila Pa 1976). 1989 Dec. 14 (12):1287-92. [QxMD MEDLINE Link].
Winter RB, Lovell WW, Moe JH. Excessive thoracic lordosis and loss of pulmonary function in patients with idiopathic scoliosis. J Bone Joint Surg Am. 1975 Oct. 57(7):972-7. [QxMD MEDLINE Link].
JAMES JI. Idiopathic scoliosis; the prognosis, diagnosis, and operative indications related to curve patterns and the age at onset. J Bone Joint Surg Br. 1954 Feb. 36-B (1):36-49. [QxMD MEDLINE Link]. [Full Text].
Robinson CM, McMaster MJ. Juvenile idiopathic scoliosis. Curve patterns and prognosis in one hundred and nine patients. J Bone Joint Surg Am. 1996 Aug. 78(8):1140-8. [QxMD MEDLINE Link].
Peterson LE, Nachemson AL. Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am. 1995 Jun. 77(6):823-7. [QxMD MEDLINE Link].
Kumar K. Spinal deformity and axial traction. Spine (Phila Pa 1976). 1996 Mar 1. 21 (5):653-5. [QxMD MEDLINE Link].
Peltier LF. Orthopaedics: A History and Iconography. San Francisco: Norman Publishing; 1993.
Marketos SG, Skiadas P. Hippocrates. The father of spine surgery. Spine. 1999 Jul 1. 24(13):1381-7. [QxMD MEDLINE Link].
LeVay D. The History of Orthopaedics: An Account of the Study and Practice of Orthopaedics from the Earliest Times to the Modern Era. Park Ridge, NJ: Parthenon Publishing; 1990.
Zimmerman, Moe JH, Winter RB. Determination of "normal" thoracic kyphosis: a roentgenographic study of 121 "normal" children. J Pediatr Orthop. 2000 Nov-Dec. 20(6):796-8. [QxMD MEDLINE Link].
Wenger DR. Idiopathic scoliosis. Wenger DR, Rang M, eds. The Art and Practice of Children's Orthopaedics. New York: Raven Press; 1993.
Bick EM. Book of Orthopaedics. New York: Hafner Publishing; 1968.
Negrini S, Zaina F, Romano M, Negrini A, Parzini S. Specific exercises reduce brace prescription in adolescent idiopathic scoliosis: a prospective controlled cohort study with worst-case analysis. J Rehabil Med. 2008 Jun. 40(6):451-5. [QxMD MEDLINE Link].
Hibbs RA. A report of fifty-nine cases of scoliosis treated by the fusion operation. By Russell A. Hibbs, 1924. Clin Orthop Relat Res. 1988 Apr. 6:4-19. [QxMD MEDLINE Link].
Shands AR, Barr JS, Colonna PC. End-Result Study of the Treatment of Idiopathic Scoliosis: Report of the Research Committee of the American Orthopaedic Association. J Bone Joint Surg. 1941. 23:963-977.
Harrington PR. Treatment of scoliosis: correction and internal fixation by spine instrumentation. June 1962. J Bone Joint Surg Am. 2002 Feb. 84-A (2):316. [QxMD MEDLINE Link].
Hall JE. Spinal surgery before and after Paul Harrington. Spine (Phila Pa 1976). 1998 Jun 15. 23 (12):1356-61. [QxMD MEDLINE Link].
Dimeglio A. Growth in pediatric orthopaedics. J Pediatr Orthop. 2001 Jul-Aug. 21 (4):549-55. [QxMD MEDLINE Link].
Canavese F, Dimeglio A. Normal and abnormal spine and thoracic cage development. World J Orthop. 2013 Oct 18. 4 (4):167-74. [QxMD MEDLINE Link]. [Full Text].
Letellier K, Azeddine B, Parent S, Labelle H, Rompré PH, Moreau A, et al. Estrogen cross-talk with the melatonin signaling pathway in human osteoblasts derived from adolescent idiopathic scoliosis patients. J Pineal Res. 2008 Nov. 45 (4):383-93. [QxMD MEDLINE Link].
Moreau A, Akoumé Ndong MY, Azeddine B, Franco A, Rompré PH, Roy-Gagnon MH, et al. [Molecular and genetic aspects of idiopathic scoliosis. Blood test for idiopathic scoliosis]. Orthopade. 2009 Feb. 38(2):114-6, 118-21. [QxMD MEDLINE Link].
Bagnall K, Raso VJ, Moreau M, et al. The effects of melatonin therapy on the development of scoliosis after pinealectomy in the chicken. J Bone Joint Surg Am. 1999 Feb. 81(2):191-9. [QxMD MEDLINE Link].
Barrack RL, Wyatt MP, Whitecloud TS 3rd, et al. Vibratory hypersensitivity in idiopathic scoliosis. J Pediatr Orthop. 1988 Jul-Aug. 8(4):389-95. [QxMD MEDLINE Link].
Wyatt MP, Barrack RL, Mubarak SJ, et al. Vibratory response in idiopathic scoliosis. J Bone Joint Surg Br. 1986 Nov. 68(5):714-8. [QxMD MEDLINE Link].
McInnes E, Hill DL, Raso VJ, et al. Vibratory response in adolescents who have idiopathic scoliosis. J Bone Joint Surg Am. 1991 Sep. 73(8):1208-12. [QxMD MEDLINE Link].
Kindsfater K, Lowe T, Lawellin D, et al. Levels of platelet calmodulin for the prediction of progression and severity of adolescent idiopathic scoliosis. J Bone Joint Surg Am. 1994 Aug. 76(8):1186-92. [QxMD MEDLINE Link].
Hadley-Miller N, Mims B, Milewicz DM. The potential role of the elastic fiber system in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 1994 Aug. 76(8):1193-206. [QxMD MEDLINE Link].
Mehlman CT, Araghi A, Roy DR. Hyphenated history: the Hueter-Volkmann law. Am J Orthop. 1997 Nov. 26(11):798-800. [QxMD MEDLINE Link].
Cheng JC, Guo X. Osteopenia in adolescent idiopathic scoliosis. A primary problem or secondary to the spinal deformity?. Spine (Phila Pa 1976). 1997 Aug 1. 22 (15):1716-21. [QxMD MEDLINE Link].
Aronsson DD, Stokes IA, Rosovsky J, Spence H. Mechanical modulation of calf tail vertebral growth: implications for scoliosis progression. J Spinal Disord. 1999 Apr. 12(2):141-6. [QxMD MEDLINE Link].
Mente PL, Stokes IA, Spence H, Aronsson DD. Progression of vertebral wedging in an asymmetrically loaded rat tail model. Spine (Phila Pa 1976). 1997 Jun 15. 22 (12):1292-6. [QxMD MEDLINE Link].
Stokes IA, Aronsson DD. Disc and vertebral wedging in patients with progressive scoliosis. J Spinal Disord. 2001 Aug. 14(4):317-22. [QxMD MEDLINE Link].
Antoniou J, Arlet V, Goswami T, Aebi M, Alini M. Elevated synthetic activity in the convex side of scoliotic intervertebral discs and endplates compared with normal tissues. Spine (Phila Pa 1976). 2001 May 15. 26 (10):E198-206. [QxMD MEDLINE Link].
Wall EJ, Bylski-Austrow DI, Kolata RJ, Crawford AH. Endoscopic mechanical spinal hemiepiphysiodesis modifies spine growth. Spine (Phila Pa 1976). 2005 May 15. 30 (10):1148-53. [QxMD MEDLINE Link].
Justice CM, Miller NH, Marosy B, Zhang J, Wilson AF. Familial idiopathic scoliosis: evidence of an X-linked susceptibility locus. Spine (Phila Pa 1976). 2003 Mar 15. 28 (6):589-94. [QxMD MEDLINE Link].
Inoue M, Minami S, Kitahara H, et al. Idiopathic scoliosis in twins studied by DNA fingerprinting: the incidence and type of scoliosis. J Bone Joint Surg Br. 1998 Mar. 80(2):212-7. [QxMD MEDLINE Link].
Kesling KL, Reinker KA. Scoliosis in twins. A meta-analysis of the literature and report of six cases. Spine (Phila Pa 1976). 1997 Sep 1. 22 (17):2009-14; discussion 2015. [QxMD MEDLINE Link].
Wise CA, Barnes R, Gillum J, Herring JA, Bowcock AM, Lovett M. Localization of susceptibility to familial idiopathic scoliosis. Spine (Phila Pa 1976). 2000 Sep 15. 25 (18):2372-80. [QxMD MEDLINE Link].
Stirling AJ, Howel D, Millner PA, et al. Late-onset idiopathic scoliosis in children six to fourteen years old. A cross-sectional prevalence study. J Bone Joint Surg Am. 1996 Sep. 78(9):1330-6. [QxMD MEDLINE Link].
Rogala EJ, Drummond DS, Gurr J. Scoliosis: incidence and natural history. A prospective epidemiological study. J Bone Joint Surg Am. 1978 Mar. 60(2):173-6. [QxMD MEDLINE Link].
Albanese SA. Idiopathic scoliosis: etiology and evaluation. Orthopaedic Knowledge Update Pediatrics. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2002. 287-96.
Henderson MH Jr, Rieger MA, Miller F, Kaelin A. Influence of parental age on degree of curvature in idiopathic scoliosis. J Bone Joint Surg Am. 1990 Jul. 72(6):910-3. [QxMD MEDLINE Link].
Karol LA, Johnston CE 2nd, Browne RH, Madison M. Progression of the curve in boys who have idiopathic scoliosis. J Bone Joint Surg Am. 1993 Dec. 75(12):1804-10. [QxMD MEDLINE Link].
Tsutsui S, Pawelek J, Bastrom T, Lenke L, Lowe T, Betz R, et al. Dissecting the effects of spinal fusion and deformity magnitude on quality of life in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2009 Aug 15. 34(18):E653-8. [QxMD MEDLINE Link].
Koch KD, Buchanan R, Birch JG, Morton AA, Gatchel RJ, Browne RH. Adolescents undergoing surgery for idiopathic scoliosis: how physical and psychological characteristics relate to patient satisfaction with the cosmetic result. Spine (Phila Pa 1976). 2001 Oct 1. 26 (19):2119-24. [QxMD MEDLINE Link].
Zhang J, Wang D, Chen Z, Gao J, Yu X, Sun H, et al. Decrease of Self-Concept in Adolescent Patients With Mild to Moderate Scoliosis After Conservative Treatment. Spine (Phila Pa 1976). 2011 Jul 1. 36(15):E1004-E1008. [QxMD MEDLINE Link].
Goldberg MS, Mayo NE, Poitras B, Scott S, Hanley J. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part I: Description of the study. Spine (Phila Pa 1976). 1994 Jul 15. 19 (14):1551-61. [QxMD MEDLINE Link].
Goldberg MS, Mayo NE, Poitras B, Scott S, Hanley J. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part II: Perception of health, self and body image, and participation in physical activities. Spine (Phila Pa 1976). 1994 Jul 15. 19 (14):1562-72. [QxMD MEDLINE Link].
Mayo NE, Goldberg MS, Poitras B, Scott S, Hanley J. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part III: Back pain. Spine (Phila Pa 1976). 1994 Jul 15. 19 (14):1573-81. [QxMD MEDLINE Link].
Poitras B, Mayo NE, Goldberg MS, Scott S, Hanley J. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part IV: Surgical correction and back pain. Spine (Phila Pa 1976). 1994 Jul 15. 19 (14):1582-8. [QxMD MEDLINE Link].
Asher MA, Lai SM, Burton DC. Analysis of instrumentation/fusion survivorship without reoperation after primary posterior multiple anchor instrumentation and arthrodesis for idiopathic scoliosis. Spine J. 2010 Jan. 10 (1):5-15. [QxMD MEDLINE Link].
Luhmann SJ, Lenke LG, Bridwell KH, Schootman M. Revision surgery after primary spine fusion for idiopathic scoliosis. Spine (Phila Pa 1976). 2009 Sep 15. 34(20):2191-7. [QxMD MEDLINE Link].
Yaszay B, Jazayeri R, Lonner B. The effect of surgical approaches on pulmonary function in adolescent idiopathic scoliosis. J Spinal Disord Tech. 2009 Jun. 22(4):278-83. [QxMD MEDLINE Link].
Gitelman Y, Lenke LG, Bridwell KH, Auerbach JD, Sides BA. Pulmonary Function in Adolescent Idiopathic Scoliosis Relative to the Surgical Procedure: A 10-Year Follow-up Analysis. Spine (Phila Pa 1976). 2011 Sep 15. 36(20):1665-72. [QxMD MEDLINE Link].
Wei-Jun W, Xu S, Zhi-Wei W, Xu-Sheng Q, Zhen L, Yong Q. Abnormal anthropometric measurements and growth pattern in male adolescent idiopathic scoliosis. Eur Spine J. 2012 Jan. 21(1):77-83. [QxMD MEDLINE Link].
Hensinger RN. Acute back pain in children. Instr Course Lect. 1995. 44:111-26. [QxMD MEDLINE Link].
Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997 Mar. 79(3):364-8. [QxMD MEDLINE Link].
Cheung KM, Luk KD. Prediction of correction of scoliosis with use of the fulcrum bending radiograph. J Bone Joint Surg Am. 1997 Aug. 79(8):1144-50. [QxMD MEDLINE Link].
Klepps SJ, Lenke LG, Bridwell KH, Bassett GS, Whorton J. Prospective comparison of flexibility radiographs in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2001 Mar 1. 26 (5):E74-9. [QxMD MEDLINE Link].
King HA, Moe JH, Bradford DS, Winter RB. The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am. 1983 Dec. 65(9):1302-13. [QxMD MEDLINE Link].
Cummings RJ, Loveless EA, Campbell J, et al. Interobserver reliability and intraobserver reproducibility of the system of King et al. for the classification of adolescent idiopathic scoliosis. J Bone Joint Surg Am. 1998 Aug. 80(8):1107-11. [QxMD MEDLINE Link].
Lenke LG, Betz RR, Bridwell KH, et al. Intraobserver and interobserver reliability of the classification of thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am. 1998 Aug. 80(8):1097-106. [QxMD MEDLINE Link].
Coonrad RW, Murrell GA, Motley G, Lytle E, Hey LA. A logical coronal pattern classification of 2,000 consecutive idiopathic scoliosis cases based on the scoliosis research society-defined apical vertebra. Spine (Phila Pa 1976). 1998 Jun 15. 23 (12):1380-91. [QxMD MEDLINE Link].
Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001 Aug. 83-A(8):1169-81. [QxMD MEDLINE Link].
Morrissy RT, Goldsmith GS, Hall EC, et al. Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Joint Surg Am. 1990 Mar. 72(3):320-7. [QxMD MEDLINE Link].
Carman DL, Browne RH, Birch JG. Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation. J Bone Joint Surg Am. 1990 Mar. 72(3):328-33. [QxMD MEDLINE Link].
Schwend RM, Hennrikus W, Hall JE, Emans JB. Childhood scoliosis: clinical indications for magnetic resonance imaging. J Bone Joint Surg Am. 1995 Jan. 77(1):46-53. [QxMD MEDLINE Link].
Ozturk C, Karadereler S, Ornek I, Enercan M, Ganiyusufoglu K, Hamzaoglu A. The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis. Int Orthop. 2010 Apr. 34 (4):543-6. [QxMD MEDLINE Link].
Brink RC, Wijdicks SPJ, Tromp IN, Schlösser TPC, Kruyt MC, Beek FJA, et al. A reliability and validity study for different coronal angles using ultrasound imaging in adolescent idiopathic scoliosis. Spine J. 2018 Jun. 18 (6):979-985. [QxMD MEDLINE Link].
de Reuver S, Brink RC, Lee TTY, Zheng YP, Beek FJA, Castelein RM. Cross-validation of ultrasound imaging in adolescent idiopathic scoliosis. Eur Spine J. 2020 Nov 6. [QxMD MEDLINE Link].
Gagnon S, Jodoin A, Martin R. Pulmonary function test study and after spinal fusion in young idiopathic scoliosis. Spine (Phila Pa 1976). 1989 May. 14 (5):486-90. [QxMD MEDLINE Link].
Kearon C, Viviani GR, Kirkley A, Killian KJ. Factors determining pulmonary function in adolescent idiopathic thoracic scoliosis. Am Rev Respir Dis. 1993 Aug. 148(2):288-94. [QxMD MEDLINE Link].
Graham EJ, Lenke LG, Lowe TG, Betz RR, Bridwell KH, Kong Y, et al. Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2000 Sep 15. 25 (18):2319-25. [QxMD MEDLINE Link].
Vedantam R, Lenke LG, Bridwell KH, Linville DL. Comparison of push-prone and lateral-bending radiographs for predicting postoperative coronal alignment in thoracolumbar and lumbar scoliotic curves. Spine (Phila Pa 1976). 2000 Jan. 25 (1):76-81. [QxMD MEDLINE Link].
Upadhyay SS, Ho EK, Gunawardene WM, et al. Changes in residual volume relative to vital capacity and total lung capacity after arthrodesis of the spine in patients who have adolescent idiopathic scoliosis. J Bone Joint Surg Am. 1993 Jan. 75(1):46-52. [QxMD MEDLINE Link].
Vedantam R, Crawford AH. The role of preoperative pulmonary function tests in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. Spine (Phila Pa 1976). 1997 Dec 1. 22 (23):2731-4. [QxMD MEDLINE Link].
Soucacos PN, Soucacos PK, Zacharis KC, et al. School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece. J Bone Joint Surg Am. 1997 Oct. 79(10):1498-503. [QxMD MEDLINE Link].
Little DG, Song KM, Katz D, Herring JA. Relationship of peak height velocity to other maturity indicators in idiopathic scoliosis in girls. J Bone Joint Surg Am. 2000 May. 82(5):685-93. [QxMD MEDLINE Link].
Aroeira RM, Leal JS, de Melo Pertence AE. New method of scoliosis assessment: preliminary results using computerized photogrammetry. Spine (Phila Pa 1976). 2011 Sep 1. 36(19):1584-91. [QxMD MEDLINE Link].
Rivard CH, Coillard C, Leroux MA. SpineCor: A New Therapeutic Approach for Idiopathic Scoliosis. Eur Spine J. 2000. 9(4):293-294.
Hsu JD, Slager UT, Swank SM, Robinson MH. Idiopathic scoliosis: a clinical, morphometric, and histopathological correlation. J Pediatr Orthop. 1988 Mar-Apr. 8(2):147-52. [QxMD MEDLINE Link].
Puzas JE, O'Keefe RJ, Lieberman JR. The orthopaedic genome: what does the future hold and are we ready?. J Bone Joint Surg Am. 2002 Jan. 84-A(1):133-41. [QxMD MEDLINE Link].
Scoliosis. Herring JA, ed. Tachdjian's Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children. 5th ed. Philadelphia: Elsevier Saunders; 2014. Vol 1: 206-307.
LLOYD-ROBERTS GC, PILCHER MF. STRUCTURAL IDIOPATHIC SCOLIOSIS IN INFANCY: A STUDY OF THE NATURAL HISTORY OF 100 PATIENTS. J Bone Joint Surg Br. 1965 Aug. 47:520-3. [QxMD MEDLINE Link]. [Full Text].
Ceballos T, Ferrer-Torrelles M, Castillo F, Fernandez-Paredes E. Prognosis in infantile idiopathic scoliosis. J Bone Joint Surg Am. 1980 Sep. 62(6):863-75. [QxMD MEDLINE Link].
Mehta MH. The rib-vertebra angle in the early diagnosis between resolving and progressive infantile scoliosis. J Bone Joint Surg Br. 1972 May. 54(2):230-43. [QxMD MEDLINE Link].
McAlindon RJ, Kruse RW. Measurement of rib vertebral angle difference. Intraobserver error and interobserver variation. Spine (Phila Pa 1976). 1997 Jan 15. 22 (2):198-9. [QxMD MEDLINE Link].
Marks DS, Iqbal MJ, Thompson AG, Piggott H. Convex spinal epiphysiodesis in the management of progressive infantile idiopathic scoliosis. Spine (Phila Pa 1976). 1996 Aug 15. 21 (16):1884-8. [QxMD MEDLINE Link].
Pratt RK, Webb JK, Burwell RG, Cummings SL. Luque trolley and convex epiphysiodesis in the management of infantile and juvenile idiopathic scoliosis. Spine (Phila Pa 1976). 1999 Aug 1. 24 (15):1538-47. [QxMD MEDLINE Link].
Figueiredo UM, James JI. Juvenile idiopathic scoliosis. J Bone Joint Surg Br. 1981 Feb. 63-B(1):61-6. [QxMD MEDLINE Link].
Gupta P, Lenke LG, Bridwell KH. Incidence of neural axis abnormalities in infantile and juvenile patients with spinal deformity. Is a magnetic resonance image screening necessary?. Spine (Phila Pa 1976). 1998 Jan 15. 23 (2):206-10. [QxMD MEDLINE Link].
Molina A, Martin C, Muñoz I, Aguilar L, Serrano S, Ballester J. Spinal intraosseous arteriovenous malformation as a cause of juvenile scoliosis. A case report. Spine (Phila Pa 1976). 1997 Jan 15. 22 (2):221-4. [QxMD MEDLINE Link].
Dubousset J, Herring JA, Shufflebarger H. The crankshaft phenomenon. J Pediatr Orthop. 1989 Sep-Oct. 9(5):541-50. [QxMD MEDLINE Link].
Hamill CL, Bridwell KH, Lenke LG, Chapman MP, Baldus C, Blanke K. Posterior arthrodesis in the skeletally immature patient. Assessing the risk for crankshaft: is an open triradiate cartilage the answer?. Spine (Phila Pa 1976). 1997 Jun 15. 22 (12):1343-51. [QxMD MEDLINE Link].
Roberto RF, Lonstein JE, Winter RB, Denis F. Curve progression in Risser stage 0 or 1 patients after posterior spinal fusion for idiopathic scoliosis. J Pediatr Orthop. 1997 Nov-Dec. 17(6):718-25. [QxMD MEDLINE Link].
Shufflebarger HL, Clark CE. Prevention of the crankshaft phenomenon. Spine (Phila Pa 1976). 1991 Aug. 16 (8 Suppl):S409-11. [QxMD MEDLINE Link].
Lee CS, Nachemson AL. The crankshaft phenomenon after posterior Harrington fusion in skeletally immature patients with thoracic or thoracolumbar idiopathic scoliosis followed to maturity. Spine (Phila Pa 1976). 1997 Jan 1. 22 (1):58-67. [QxMD MEDLINE Link].
Negrini S, Donzelli S, Negrini A, Parzini S, Romano M, Zaina F. Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: A practical clinical trial. Ann Phys Rehabil Med. 2019 Mar. 62 (2):69-76. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018. 13:3. [QxMD MEDLINE Link]. [Full Text].
Moe JH, Kettleson DN. Idiopathic scoliosis. Analysis of curve patterns and the preliminary results of Milwaukee-brace treatment in one hundred sixty-nine patients. J Bone Joint Surg Am. 1970 Dec. 52(8):1509-33. [QxMD MEDLINE Link].
Lonstein JE, Winter RB. The Milwaukee brace for the treatment of adolescent idiopathic scoliosis. A review of one thousand and twenty patients. J Bone Joint Surg Am. 1994 Aug. 76(8):1207-21. [QxMD MEDLINE Link].
Noonan KJ, Weinstein SL, Jacobson WC, Dolan LA. Use of the Milwaukee brace for progressive idiopathic scoliosis. J Bone Joint Surg Am. 1996 Apr. 78(4):557-67. [QxMD MEDLINE Link].
Maruyama T, Takeshita K, Kitagawa T. Milwaukee brace today. Disabil Rehabil Assist Technol. 2008 May. 3(3):136-8. [QxMD MEDLINE Link].
Rowe DE, Bernstein SM, Riddick MF, et al. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am. 1997 May. 79(5):664-74. [QxMD MEDLINE Link].
Nachemson AL, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am. 1995 Jun. 77(6):815-22. [QxMD MEDLINE Link].
Allington NJ, Bowen JR. Adolescent idiopathic scoliosis: treatment with the Wilmington brace. A comparison of full-time and part-time use. J Bone Joint Surg Am. 1996 Jul. 78(7):1056-62. [QxMD MEDLINE Link].
Payne WK 3rd, Ogilvie JW, Resnick MD, Kane RL, Transfeldt EE, Blum RW. Does scoliosis have a psychological impact and does gender make a difference?. Spine (Phila Pa 1976). 1997 Jun 15. 22 (12):1380-4. [QxMD MEDLINE Link].
MacLean WE Jr, Green NE, Pierre CB, Ray DC. Stress and coping with scoliosis: psychological effects on adolescents and their families. J Pediatr Orthop. 1989 May-Jun. 9(3):257-61. [QxMD MEDLINE Link].
DiRaimondo CV, Green NE. Brace-wear compliance in patients with adolescent idiopathic scoliosis. J Pediatr Orthop. 1988 Mar-Apr. 8(2):143-6. [QxMD MEDLINE Link].
Aubin CE, Labelle H, Ruszkowski A, Petit Y, Gignac D, Joncas J, et al. Variability of strap tension in brace treatment for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 1999 Feb 15. 24 (4):349-54. [QxMD MEDLINE Link].
Wynne JH. The Boston Brace and TriaC systems. Disabil Rehabil Assist Technol. 2008 May. 3(3):130-5. [QxMD MEDLINE Link].
Kessler JI. Efficacy of a new computer-aided design/computer-aided manufacture orthosis in the treatment of adolescent idiopathic scoliosis. J Pediatr Orthop B. 2008 Jul. 17(4):207-11. [QxMD MEDLINE Link].
Coillard C, Circo A, Rivard CH. A new concept for the non-invasive treatment of Adolescent Idiopathic Scoliosis: the Corrective Movement principle integrated in the SpineCor System. Disabil Rehabil Assist Technol. 2008 May. 3(3):112-9. [QxMD MEDLINE Link].
Gutman G, Benoit M, Joncas J, Beauséjour M, Barchi S, Labelle H, et al. The effectiveness of the SpineCor brace for the conservative treatment of adolescent idiopathic scoliosis. Comparison with the Boston brace. Spine J. 2016 May. 16 (5):626-31. [QxMD MEDLINE Link].
Lenke LG, Bridwell KH, Blanke K, et al. Radiographic results of arthrodesis with Cotrel-Dubousset instrumentation for the treatment of adolescent idiopathic scoliosis. A five to ten-year follow-up study. J Bone Joint Surg Am. 1998 Jun. 80(6):807-14. [QxMD MEDLINE Link].
Mielke CH, Lonstein JE, Denis F, et al. Surgical treatment of adolescent idiopathic scoliosis. A comparative analysis. J Bone Joint Surg Am. 1989 Sep. 71(8):1170-7. [QxMD MEDLINE Link].
Lenke LG, Bridwell KH, Baldus C, et al. Cotrel-Dubousset instrumentation for adolescent idiopathic scoliosis. J Bone Joint Surg Am. 1992 Aug. 74(7):1056-67. [QxMD MEDLINE Link].
Rajasekaran S, Dorgan JC, Taylor JF, Dangerfield PH. Eighteen-level analysis of vertebral rotation following Harrington- Luque instrumentation in idiopathic scoliosis. J Bone Joint Surg Am. 1994 Jan. 76(1):104-9. [QxMD MEDLINE Link].
Jarvis JG, Greene RN. Adolescent idiopathic scoliosis. Correction of vertebral rotation with use of Wisconsin segmental spinal instrumentation. J Bone Joint Surg Am. 1996 Nov. 78(11):1707-12. [QxMD MEDLINE Link].
Mehlman CT, Crawford AH, Wolf RK. Video-assisted thoracoscopic surgery (VATS). Endoscopic thoracoplasty technique. Spine (Phila Pa 1976). 1997 Sep 15. 22 (18):2178-82. [QxMD MEDLINE Link].
Crawford AH, Wall EJ, Wolf R. Video-assisted thoracoscopy. Orthop Clin North Am. 1999 Jul. 30(3):367-85, viii. [QxMD MEDLINE Link].
Wall EJ, Bylski-Austrow DI, Shelton FS, Crawford AH, Kolata RJ, Baum DS. Endoscopic discectomy increases thoracic spine flexibility as effectively as open discectomy. A mechanical study in a porcine model. Spine (Phila Pa 1976). 1998 Jan 1. 23 (1):9-15; discussion 15-6. [QxMD MEDLINE Link].
Huntington CF, Murrell WD, Betz RR, Cole BA, Clements DH 3rd, Balsara RK. Comparison of thoracoscopic and open thoracic discectomy in a live ovine model for anterior spinal fusion. Spine (Phila Pa 1976). 1998 Aug 1. 23 (15):1699-702. [QxMD MEDLINE Link].
Picetti G 3rd, Blackman RG, O''Neal K, Luque E. Anterior endoscopic correction and fusion of scoliosis. Orthopedics. 1998 Dec. 21(12):1285-7. [QxMD MEDLINE Link].
Hoppenfeld S, Gross A, Andrews C, Lonner B. The ankle clonus test for assessment of the integrity of the spinal cord during operations for scoliosis. J Bone Joint Surg Am. 1997 Feb. 79(2):208-12. [QxMD MEDLINE Link].
Lehman RA Jr, Lenke LG, Keeler KA, Kim YJ, Buchowski JM, Cheh G, et al. Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs: minimum three-year follow-up of one hundred fourteen cases. Spine (Phila Pa 1976). 2008 Jun 15. 33 (14):1598-604. [QxMD MEDLINE Link].
Kawaguchi Y, Yabuki S, Styf J, Olmarker K, Rydevik B, Matsui H, et al. Back muscle injury after posterior lumbar spine surgery. Topographic evaluation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine (Phila Pa 1976). 1996 Nov 15. 21 (22):2683-8. [QxMD MEDLINE Link].
Ebraheim NA, Xu R, Ahmad M, Yeasting RA. The quantitative anatomy of the thoracic facet and the posterior projection of its inferior facet. Spine (Phila Pa 1976). 1997 Aug 15. 22 (16):1811-7; discussion 1818. [QxMD MEDLINE Link].
Boseker EH, Moe JH, Winter RB, Koop SE. Determination of "normal" thoracic kyphosis: a roentgenographic study of 121 "normal" children. J Pediatr Orthop. 2000 Nov-Dec. 20(6):796-8. [QxMD MEDLINE Link].
Regan JJ, Araghi A. Thoracoscopic exposures. Zdeblick TA, ed. Anterior Approaches to the Spine. St Louis: Quality Medical Publishing; 1999. 125-49.
Leong JJ, Curtis M, Carter E, Cowan J, Lehovsky J. Risk of Neurological Injuries in Spinal Deformity Surgery. Spine (Phila Pa 1976). 2016 Jun. 41 (12):1022-7. [QxMD MEDLINE Link].
McKie JS, Herzenberg JE. Coagulopathy complicating intraoperative blood salvage in a patient who had idiopathic scoliosis. A case report. J Bone Joint Surg Am. 1997 Sep. 79(9):1391-4. [QxMD MEDLINE Link].
Potenza V, Weinstein SL, Neyt JG. Dysfunction of the spinal cord during spinal arthrodesis for scoliosis: recommendations for early detection and treatment. A case report. J Bone Joint Surg Am. 1998 Nov. 80(11):1679-83. [QxMD MEDLINE Link].
Neyt JG, Weinstein SL. Fracture-dislocation of the lumbar spine after arthrodesis with instrumentation for idiopathic scoliosis. J Bone Joint Surg Am. 1999 Jan. 81(1):111-4. [QxMD MEDLINE Link].
Richards BS. Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg Am. 1995 Apr. 77(4):524-9. [QxMD MEDLINE Link].
Sanders JO, Herring JA, Browne RH. Posterior arthrodesis and instrumentation in the immature (Risser-grade- 0) spine in idiopathic scoliosis. J Bone Joint Surg Am. 1995 Jan. 77(1):39-45. [QxMD MEDLINE Link].
Kostuik JP. Operative treatment of idiopathic scoliosis. J Bone Joint Surg Am. 1990 Aug. 72(7):1108-13. [QxMD MEDLINE Link].
Dickson JH, Erwin WD, Rossi D. Harrington instrumentation and arthrodesis for idiopathic scoliosis. A twenty-one-year follow-up. J Bone Joint Surg Am. 1990 Jun. 72(5):678-83. [QxMD MEDLINE Link].
Roush TF, Crawford AH, Berlin RE, Wolf RK. Tension pneumothorax as a complication of video-assisted thorascopic surgery for anterior correction of idiopathic scoliosis in an adolescent female. Spine (Phila Pa 1976). 2001 Feb 15. 26 (4):448-50. [QxMD MEDLINE Link].
Huang TJ, Hsu RW. Chylothorax after video-assisted thoracoscopic release for rigid scoliosis. Orthopedics. 2001 Aug. 24(8):789-90. [QxMD MEDLINE Link].

Media Gallery

Mild juvenile scoliosis.
Anteroposterior (AP) radiograph shows mild adolescent scoliosis.
Lateral view of mild adolescent scoliosis.
Moderate scoliosis.

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Author

Charles T Mehlman, DO, MPH Professor of Pediatrics and Pediatric Orthopedic Surgery, Division of Pediatric Orthopedic Surgery, Director, Musculoskeletal Outcomes Research, Cincinnati Children's Hospital Medical Center

Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, AOSpine, Cervical Spine Research Society, International Society for the Advancement of Spine Surgery, International Society for the Study of the Lumbar Spine, Lumbar Spine Research Society, North American Spine Society, Scoliosis Research Society, Society of Lateral Access Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic, Nuvasive, NLT Spine, RTI, Magellan Health<br/>Received consulting fee from Medtronic for consulting; Received consulting fee from NuVasive for consulting; Received royalty from Nuvasive for consulting; Received consulting fee from K2M for consulting; Received ownership interest from NuVasive for none.