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Adolescent idiopathic scoliosis (AIS)
Scoliosis is a sideways curve of the spine of more than 10 degrees by the Cobb angle with vertebral rotation; the choice between observation, bracing and surgery depends on curve size and on how much growth remains.
Why it matters in the exam
The typical stem describes a girl aged 10–14 whose mother noticed one shoulder higher, a prominent shoulder blade or an uneven waistline, without significant pain. The key examination is the Adams forward bend test, which shows a rib hump on the convex side; a scoliometer reading of 7 degrees or more justifies a standing full-spine radiograph. Small curves are equally common in both sexes, but curves that progress and need treatment are several times more common in girls. The risk of progression is high when the curve is large, when menarche has not yet occurred and when the Risser sign is low, meaning much growth remains. Advanced questions deal with warning signs that call for MRI: a left thoracic curve, persistent night pain, neurological findings, rapid progression or very young age. Remember that idiopathic scoliosis does not usually cause severe pain, and that curves above 50 degrees may keep progressing in adult life at about one degree a year, so they are usually treated surgically. In follow-up questions, remember that repeat radiographs are taken standing with the lowest possible radiation dose, and that a change counts as real only when it is larger than the measurement error. In addition, ask about a family history of scoliosis, which raises the risk, and assess sexual maturity by Tanner stage.
Key points
- Idiopathic scoliosis: Cobb angle above 10 degrees with vertebral rotation, mainly in adolescent girls.
- The Adams test and scoliometer for screening; a standing radiograph for diagnosis.
- Progression risk: large curve, before menarche and low Risser sign.
- 25–40 degrees with growth remaining — brace; above 45–50 — surgery.
- Left thoracic curve, night pain or neurological deficit — MRI.
Summary table
| Cobb angle | Growth status | Usual treatment |
|---|---|---|
| 10–25 degrees | Any | Clinical observation and radiographs every 4–6 months during growth |
| 25–40 degrees | Growth remaining (Risser 0–2) | Brace for most of the day, at least 13 hours daily |
| 25–40 degrees | Growth finished | Observation; no brace, because a brace does not correct an existing curve |
| Above 45–50 degrees | Any age | Posterior spinal fusion with instrumentation |
| Any curve with warning signs | Any | MRI of the whole spine before deciding on treatment |
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Sources
- Lovell and Winter's Pediatric Orthopaedics, 8th ed. (2020) — Idiopathic Scoliosis
- SRS/SOSORT consensus on conservative treatment of idiopathic scoliosis, 2016 — Bracing and Observation
- Apley and Solomon's System of Orthopaedics and Trauma, 10th ed. (2017) — The Back
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.