Juvenile and adolescent idiopathic scoliosis

Idiopathic scoliosis is the most common structural deformity of the spine in the juvenile and adolescent populations. It is a complex, three-dimensional torsional change of the spinal column for which no definitive etiology can be determined. The focus of orthopaedic treatment is to prevent curve progression through bracing and/or surgery. Although the efficacy of bracing has been proved in recent years, much research has been focused on predicting which patients will have curve progression despite appropriate brace management. In the juvenile population, treatment strategies are aimed at preventing curve progression while allowing the spinal column and thorax to grow to an appropriate size. In adolescents with a progressive curve, surgical intervention may prevent progression while obtaining appropriate spinal balance in the coronal and sagittal planes. Complications in the treatment of idiopathic scoliosis can be categorized as postoperative infection, pseudarthrosis, and the very rarely occurring neurologic deficits. Important advances in standardizing patient care have markedly diminished the frequency of these complications. Current research is focused on improving the quality of care and minimizing the risks of complications.