Adolescent Idiopathic Scoliosis: Understanding the Condition and Its Implications

Adolescent idiopathic scoliosis (AIS) is a condition characterized by an abnormal curvature of the spine that typically appears in children aged 10 to 18. The term "idiopathic" indicates that the exact cause of this condition is unknown. AIS primarily affects the frontal plane of the spine but can also involve deformities in the sagittal and axial planes, leading to a three-dimensional spinal deformity.

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Incidence and Demographics

AIS is relatively common among adolescents. The incidence of AIS varies based on the severity of the spinal curvature:

• Curves between 10° to 20°: Approximately 3% of adolescents within the affected age group exhibit these mild curves.
• Curves greater than 30°: The incidence drops significantly to about 0.3%, highlighting the relative rarity of more severe cases.

The condition demonstrates a marked gender disparity, with females being ten times more likely to develop AIS than males. This significant gender ratio underscores the importance of targeted awareness and screening efforts among female adolescents.

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Causes:

Usually unknown cause (Idiopathic)

Mostly has a positive family history

Signs &Symptoms:

·????? Asymptomatic

·????? Back disfigurement

·????? Back pain

·????? Unleveled shoulders

·????? Rib hump with forewarned bending

·????? Waist asymmetry

·????? Truncal shifts

·????? Psychological problems from the shape

·????? Respiratory and cardiac problems in very severe curves

·????? Mostly occurs in the thoracic spine but also can occur in the lumbar spine

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Diagnosis:

• Proper clinical examination by a specialized doctor
• Radiology: Full-length spine X-rays from cervical spine to hips, both AP and lateral standing, and supine bending views to check flexibility of the curves MRI to rule out any associated spinal cord abnormalities, such as syrinx CT scans to detect vertebral abnormalities, e.g., congenital hemivertebrae Respiratory function tests in severe thoracic curves

Treatment: Based on the patient's skeletal maturity, the magnitude of deformity, and curve progression, early detection and screening of children at school age are crucial.

Options:

• Observation: For Cobb angle < 25°. Obtain serial X-rays to monitor for progression of the deformity.
• Bracing: For Cobb angle from 25° to 40°. Only effective for flexible deformities in skeletally immature patients. The goal is to stop progression, not to correct the deformity.
• Surgical Correction: With the aid of somatosensory cord monitoring for larger curves with instrumentation and fusion of the spine, either done in a single session or 2 sessions. Posterior Spinal Fusion: Indications: Cobb angle > 45°. Can be used for all types of idiopathic scoliosis. Remains the gold standard for thoracic and double major curves (most cases). Anterior Spinal Fusion: Indications: Best for thoracolumbar and lumbar cases with a normal sagittal profile. Anterior/Posterior Spinal Fusion: Indications: Large curves (> 75°) or stiff curves. Young age (Risser grade 0, girls <10 yrs, boys <13 yrs) to prevent the crankshaft phenomenon.

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Conclusion

Adolescent idiopathic scoliosis (AIS) presents a significant challenge in pediatric healthcare, primarily affecting individuals aged 10 to 18 with a higher prevalence in females. Despite its unknown cause, the condition can lead to severe physical and psychological consequences if left untreated. Early detection through clinical examinations and radiological evaluations is crucial for effective management. Treatment options vary from observation and bracing for milder cases to surgical intervention for more severe curves. By promoting early screening and individualized treatment plans, healthcare providers can improve outcomes and quality of life for adolescents with AIS. As understanding and techniques continue to advance, the goal remains to offer comprehensive care that addresses both the physical deformity and the associated health impacts of AIS.

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