All cristae have curves. Some curves are normal, such as those in the neck and above and below the trunk. The body needs these flexures to maintain balance and alignment of the upper body over the pelvis. However, when there is an abnormal side-to-side (lateral) curvature of the crest, we call it scoliosis. Scoliosis occurs in 2% of women and 0.5% of men. There are many causes of scoliosis, including congenital, hereditary, neuromuscular, and limb length inequality. Other causes of scoliosis include cerebral palsy, kyphoscoliosis, muscular dystrophy, kyphoscoliosis, and tumors. However, more than 80% of scoliosis cases are idiopathic, meaning that the cause is unknown. Most cases of idiopathic scoliosis occur in patients who are healthy in other systems of the body. Idiopathic scoliosis is divided into four categories based on age: 1) Infancy: 3 years of age and younger; 2) Childhood: 3-9 years of age; 3) Adolescence: 10-18 years of age; and 4) Adulthood: after skeletal maturity. The most common type of scoliosis is Adolescent Idiopathic Scoliosis (AIS), which tends to occur between puberty and adulthood, and accounts for 80 percent of all idiopathic scoliosis cases, and early detection is the key. Early detection is the key. Early signs of scoliosis are not obvious, especially when wearing clothing, and most adolescents with scoliosis are detected by parents when their child is bathing or wearing less clothing. If you notice the following signs in your child, you should be alerted to the possibility of scoliosis, such as: uneven neckline, one shoulder is higher than the other; asymmetric development of both breasts in girls, with the left breast tends to be larger; one side of the back is bulging; one side of the waist is wrinkled; one side of the hips is higher than the other; and the lower limbs of the two sides are not equal in length. At this point, you can give your child some simple checks, such as touching the spines of the crest to see if they are in a straight line, or letting your child stand upright and then bend forward to see if the back is symmetrical. If, after a simple examination, you find that your child has an abnormality, you should go to the hospital immediately. If there is a suspicion, an X-ray, CT or MRI of the crest is usually done to confirm the diagnosis of scoliosis. The degree of curvature is usually measured using the Cobb’s angle method. In general, a curvature in the range of 25 to 30 degrees is considered significant. A curvature in the 45 to 50 range is considered severe and usually requires surgery. Once a patient has been diagnosed with scoliosis, there are several things to consider when choosing a treatment: 1. Is the crest mature? Is the patient’s crest continuing to grow and develop? 2, What is the degree of curvature and how much does the scoliosis affect the patient’s quality of life. 3, The location of the scoliosis. According to the Crestal Scoliosis Association, thoracic scoliosis progresses more rapidly than thoracolumbar scoliosis and lumbar scoliosis. 4, the possible line of progression. Large scoliosis before the rapid growth period of youth has a high likelihood of scoliosis progression. The above factors should be fully considered before determining the treatment program. And the treatment has the following three basic treatment options. 1. Observation 2. Bracing 3. Surgery Since most crestal scoliosis does not progress to the stage where surgery is necessary, non-surgical treatment is always used as the first attempted treatment to initially control the progression of scoliosis. Bracing is usually used in children with scoliosis of 25-40 degrees to prevent further progression of the scoliosis. In general, scoliosis occurs predominantly in the thoracolumbar region and may present with pulmonary dysfunction, mostly restrictive ventilation if the thoracic deformity is severe, and cardiac dysfunction as the scoliosis worsens. Surgery is the treatment of choice for severe scoliosis (scoliosis angle greater than 45 degrees) and for scoliosis that does not respond to brace therapy. The goal of surgical treatment is twofold: to stop the progression of scoliosis and to correct the crestal deformity. Surgical procedures for crestal scoliosis have recently evolved rapidly with improved surgical techniques and surgical instruments. The most commonly used surgical procedure is posterior internal fixation of the crestal column with bone graft fusion, in which a metal rod is implanted on both sides of the crestal column and then an iliac bone graft is taken and the graft grows between the vertebral plates in a process called crestal fusion. The implant grows between the vertebral plates in a process called crural fusion. Before the implants are fused, the metal rods hold the crural column in place. Currently, with improved surgical techniques, most patients are discharged from the hospital one week after surgery and do not require postoperative bracing. Most patients are able to attend school and are able to perform their usual activities after 4-6 months. The alternative is an anterior approach where the incision is made in the chest wall. The incision is smaller than conventional surgery. The anterior approach has the following advantages: unobtrusive, quick recovery, high crestal stability, and fewer fused segments. Most patients require postoperative brace protection for several months. Typically, scoliosis patients can be out of the hospital 3-4 days after surgery and discharged within 1-2 weeks. With current medical technology, most patients can do exercise such as swimming 4-6 weeks after surgery, jogging in 3 months, and non-contact confrontational sports activities in about a year.