Management of Adolescent Idiopathic Scoliosis in Adults

Understanding the Condition

The American College of Radiology states that AIS is the most common type of scoliosis, occurring in 1-2% of otherwise healthy children and constituting 75-80% of all scoliosis cases 1
AIS is more common in females, with a female-to-male ratio of 10:1 for larger curves (>40°) 1

Regular radiographic monitoring is essential to track potential curve progression, as recommended by the American College of Radiology 1, 2
Skeletally mature patients with thoracic scoliosis greater than 50° may continue to progress at approximately 1° per year, requiring more vigilant monitoring 1
The American College of Radiology suggests that MRI evaluation should be considered if new neurological symptoms develop or if the curve shows unexpected progression, although this specific recommendation is from Praxis Medical Insights 3
Physical therapy focusing on core strengthening and postural awareness can help manage symptoms, according to Praxis Medical Insights 4
Pain management strategies may include regular stretching exercises, non-steroidal anti-inflammatory medications, and physical modalities such as heat or massage, as suggested by Praxis Medical Insights 3, 4

Surgical treatment should be considered for curves greater than 50° due to the risk of continued progression into adulthood, as well as for documented curve progression despite skeletal maturity 1
Significant pain not responding to conservative measures and significant cosmetic concerns affecting quality of life may also necessitate surgical intervention, although the latter is not directly cited 4

Development of new neurological symptoms, rapid curve progression, functionally disruptive pain, and focal neurological findings on examination require urgent evaluation, as indicated by the American College of Radiology and Praxis Medical Insights 2, 4
Excessive radiation exposure from too-frequent radiographs should be avoided by following recommended monitoring intervals, as advised by the American College of Radiology 2
Assuming no progression due to the absence of symptoms and delaying evaluation of new or worsening symptoms are common pitfalls to avoid, according to the American College of Radiology and Praxis Medical Insights 1, 4

Postural awareness training teaches adolescents to maintain proper alignment during daily activities, reducing the tendency to lean on one side that can exacerbate scoliosis 5, 6
Maintaining assisted ambulation through proper core strength and posture may prevent scoliosis progression and further deterioration of lung function in adolescents 7

Postural awareness training should include education on maintaining an upright stable position during all activities 7
Postural awareness training should include techniques to avoid leaning on the same elbow or side, which can worsen scoliosis 6

Scoliosis in adolescents can aggravate restrictive lung disease due to an imbalance between altered respiratory mechanics and respiratory muscle strength, making core and respiratory muscle training particularly important 8