Scoliosis is a symptom and there are many causes that can lead to scoliosis, each with its own characteristics. In order for treatment to be effective, the types should be differentiated and targeted. Scoliosis can be categorized into functional and organic, or non-structural and structural. I. Non-structural scoliosis: 1, postural scoliosis; 2, lumbar and leg pain, such as disc herniation, tumors; 3, caused by the unequal length of the lower limbs; 4, caused by hip contracture; 5, inflammatory stimuli (such as appendicitis); 6, hysterical scoliosis. Non-structural scoliosis refers to temporary scoliosis caused by certain reasons, which can be returned to normal once the cause is removed, but those who have existed for a long time can also develop into structural scoliosis. Generally, scoliosis can disappear on its own when the patient is lying down, and the bony structures of the spine are normal in X-ray filming. Structural scoliosis: 1. Idiopathic scoliosis is the most common, accounting for 75%-85% of the total number of patients. The cause of the disease is not clear, so it is called idiopathic scoliosis. According to the age of onset, it can be divided into three categories. (1) Infantile type (0-3 years old). (2) Juvenile type (4-10 years old). (3) Adolescent type (>10 years old to skeletal maturity). (2) Congenital (1) Poorly formed type. (2) Dysplastic type. (3) Mixed type, combining both of the above types. Congenital scoliosis is caused by asymmetrical growth of both sides of the spine due to incomplete segmentation of the vertebrae, bone bridges on one side, incomplete development of the vertebrae on the other side, or a combination of both of the above factors during the embryonic period. Often combined with other malformations, including spinal cord malformation, congenital heart disease, congenital urinary tract malformation, etc., usually in the X-ray film can be found in the spinal development deformity. 3, neuromuscular can be divided into neurogenic and myogenic, is due to neurological or muscular disorders leading to muscle imbalance, especially paraspinal muscle asymmetry caused by scoliosis. Common causes include post-polio syndrome, cerebral palsy, spinal cord cavernous disease, progressive myasthenia gravis and so on. 4.Neurofibromatosis combined with scoliosis. 5, scoliosis caused by interstitial lesions such as equine syndrome, congenital polyarticular contracture and so on. Acquired scoliosis such as ankylosing spondylitis, spinal fracture, spinal tuberculosis, pyothorax, thoracoplasty and other thoracic surgeries caused by scoliosis. Other causes such as metabolic, nutritional or endocrine causes of scoliosis. Early diagnosis of scoliosis Early detection and early treatment is the key to prevent the deformity from developing seriously. Early manifestations of scoliosis include: uneven shoulders, deviation of the spine from the center line, high and low scapulae, wrinkled skin lines on one side of the chest, and asymmetry of the back on both sides when bending forward. Early detection depends mainly on parents, school teachers and school nurses. A simple test is the bend test: let the child take off his shirt and stand on a flat surface with both feet in an upright position. With the palms of the hands together, place the hands between the knees and gradually bend over. The examiner sits in front of or behind the child and looks at the child with flat eyes to see if both sides of the back are equal, and if one side is found to be high, this indicates that there may be sideways bending accompanied by bulging due to vertebral body rotation. If the bending test is positive, the child should go to the hospital for timely consultation. (1) X-ray examination is the most important, generally with the help of X-ray film can distinguish the cause of scoliosis, classification, as well as the degree of curvature, location, rotation, bone age, degree of compensation. Routine X-rays should include a full-length frontal and lateral view of the spine in the standing position, including the lower cervical vertebrae at the upper end and the lumbosacral joints and iliac flanks bilaterally at the lower end. Other special radiographs include supine scoliosis radiographs, traction radiographs, etc., which can assess the flexibility of scoliosis. (2) CT scan can show the bony deformity very well, especially the three-dimensional reconstruction CT of the spine can show the congenital vertebral deformity very well, and also can do myelography CT scan, which can show the relationship between the vertebrae and nerves and the presence or absence of spinal deformity in some complex spinal deformity, and guide the surgical treatment. (3) Magnetic resonance imaging (MRI) Compared with myelography, which is a non-invasive examination with high soft tissue resolution, it can show spinal cord lesions very well. 3.Neurological examination Every scoliosis patient should undergo a detailed and comprehensive neurological examination, on the one hand, pay attention to whether scoliosis leads to spinal cord compression, causing paraplegia, early tendon hyperreflexia and pathological reflexes; on the other hand, pay attention to whether there is any combination of spinal cord abnormalities such as spinal bulge, longitudinal fissure of the spinal cord, spinal cord cavernous. Treatment of scoliosis can be divided into two main categories, i.e. non-surgical treatment and surgical treatment. Common non-surgical treatments include physical therapy, gymnastic therapy, plaster, brace, etc., but the main and most reliable method is brace treatment. Generally, idiopathic scoliosis within 20 degrees can be left untreated for close observation, and if it worsens more than 5 degrees per year, then brace treatment should be performed. Adolescent idiopathic scoliosis with a first diagnosis of 30 degrees to 40 degrees should be braced immediately, because more than 60% of this group of patients will develop and worsen. Surgery should be considered for adolescent idiopathic scoliosis in the following cases: (1) thoracic curvature greater than 40 degrees, thoracolumbar curvature/lumbar curvature greater than 35 degrees; (2) rapid progression of the curvature that cannot be controlled by bracing; (3) significant low back pain or symptoms of nerve compression. Patients with congenital scoliosis should be operated as early as possible if the scoliosis is easy to progress or if the scoliosis progresses significantly during the observation period, and generally 3 to 5 years old is a good time for surgery. Due to the complexity of scoliosis etiology and the many types of scoliosis, the need for surgery is not simply based on the patient’s age or the degree of scoliosis, but should also take into account the type of deformity, characteristics, segments, rate of progression, the patient’s bone age and development and the degree to which the deformity affects the patient’s physical appearance and other factors. There is a consensus that progressive congenital scoliosis should be operated early because the deformity not only worsens with age, but also becomes rigid and difficult to correct. However, if idiopathic scoliosis is corrected and fused posteriorly too early in childhood, it may affect the growth and development of the spine, and the deformity is likely to worsen in the long term. In addition, the balance of the spine and the effect of surgery on the growth and mobility of the spine should also be taken into account. Therefore each scoliosis patient should be analyzed specifically and individualized treatment measures should be taken. The objectives of scoliosis surgery are: to prevent the progression of the deformity; to restore the balance of the spine; to correct the deformity as much as possible; to preserve as many movable segments of the spine as possible; and to prevent nerve damage. With the current three-dimensional orthopedic technique and pedicle screw fixation technique, scoliosis can be well surgically corrected, but it cannot be 100% corrected because the surgery has to consider the tolerance of the patient’s spine and spinal cord, and overcorrection may easily lead to failure of internal fixation, increase the incidence of surgical complications, and even lead to nerve damage and paralysis. The degree of scoliosis correction varies with different ages, degrees and etiologies. Generally, the correction rate of idiopathic scoliosis can reach 60% to 80%. Scoliosis is a common disease that harms teenagers and children. If not detected and treated in time, it can develop into a very serious deformity and affect cardiopulmonary function, and even lead to paralysis in severe cases. School-age children should pay attention to maintaining good sitting and standing posture and strengthening muscle exercise. The key to preventing and treating scoliosis is early detection, early diagnosis and early treatment, and the knowledge of scoliosis prevention and treatment should be promoted in schools, and scoliosis screening should be carried out on a regular basis.