Summer is here, a time when children wear fewer clothes and abnormalities of the spine are relatively easy to detect. Since screening of the spine is not yet common in most parts of the country, parents are reminded to pay attention to your child’s spine! The following is a brief introduction to one of the most common types of spinal surgery disorders in children: adolescent idiopathic scoliosis (curvature). If the disease is detected and treated early, most children can avoid major surgery and costly procedures. Idiopathic scoliosis is a curvature of the spine more than 10 degrees to the side, combined with rotation of the spine, without other organic disease. Idiopathic scoliosis accounts for approximately 85% of all scoliosis patients. Adolescent idiopathic scoliosis (between the ages of 11-18 years) accounts for more than 80% of idiopathic scoliosis. It is more common in girls than in boys. The etiology of idiopathic scoliosis is not known. About 30% of patients have a positive family history. What are the signs of adolescent idiopathic scoliosis? 1. The shoulders are not equal in height, and girls may have asymmetry in the hemline of the skirt on both sides when wearing a dress. 2. Asymmetry of the back. Due to scoliosis, severe cases can cause significant asymmetry of the thoracic back or low back, and can have razor back and thoracic deformity. Mild cases can be examined by the forward flexion test, which is an important method for diagnosing idiopathic scoliosis. The person examined stands with his hands bent forward flush, and the examiner observes in front of him whether there is symmetry on both sides of his back. 3. Back pain: About 23% of patients who visit the clinic have back pain. And most patients can have no other clinical symptoms except back deformity. 4. Cardiorespiratory involvement: Severe deformities can affect cardiorespiratory function. How is adolescent idiopathic scoliosis diagnosed? The diagnosis can usually be established through history, physical examination and X-ray. However, the following disorders should be excluded: (i) scoliosis caused by neurological abnormalities such as cerebral palsy, poliomyelitis, spina bifida, and Chiari malformation. ②Neurofibromatosis: scoliosis is often suggested if patients with scoliosis are found to have multiple milk coffee spots on the skin during physical examination. Some diseases such as Marfan syndrome can also be combined with scoliosis. What special tests are needed for adolescent idiopathic scoliosis? X-rays are the primary means of diagnosing and evaluating the disease. MRI is not usually required for idiopathic scoliosis. MRI is helpful in removing intracanal lesions such as spinal cavities, Chiari malformation, spinal cord tethering and longitudinal spinal bifida. How can adolescents with idiopathic scoliosis be treated conservatively? 1. Observation: When the Cobb angle of the child is <25 degrees, adolescents who are not yet mature should be followed up every 4 to 6 months for dynamic observation. 2. Sports therapy: Sports therapy alone is not effective in the treatment of the disease, but in conjunction with therapy. 3. Bracing: Bracing is the only non-surgical measure that can affect the progression of idiopathic scoliosis in adolescents and has good control in mild patients, with an efficiency of about 75%. The brace needs to be worn for more than 23 hours a day and reviewed every 4 to 6 months to evaluate the effect of brace therapy and to make necessary adjustments to the brace. Bracing therapy should be continued until skeletal maturity. How is surgery performed for adolescent idiopathic scoliosis? Indications for surgical treatment: Cobb's angle is greater than 45 to 50 degrees and the skeleton has not yet matured. Surgical approach: Posterior surgery with autogenous spinal implant fusion is the gold standard for the treatment of AIS. Depending on the patient's scoliosis, anterior surgery and a combination of anterior and posterior surgery may also be used. Is surgery for adolescent idiopathic scoliosis risky? With advances in surgical techniques, the chance of spinal cord injury is now less than 1%.