Since the publication of the editor’s post, “Adolescent idiopathic scoliosis 50 years on: Living comfortably without treatment,” there has been a great deal of interest and discussion in the domestic spine academic community. It was the editor’s intention to compile the essence of the 2003 JAMA article in its original form and pass this information on to the millions of adolescent idiopathic scoliosis patients and their families in China. The response from the academic spine community was significant, demonstrating the rigorous and scientific spirit of the academic community and teachers, and the seriousness and responsibility of the patients, on the one hand, and the fact that the 2003 JAMA article had not previously attracted the attention of the domestic academic community on the other. Twelve years later, this issue has sparked a debate, which is undoubtedly beneficial to our quest for the true meaning of disease treatment and to the majority of adolescent idiopathic scoliosis patients and their families; a hundred schools of thought, which advocate academic debate and discussion, is undoubtedly beneficial to a scientific and serious academic culture. The editor in everywhere, are very respectful of their own teachers and seniors, practice “disciple rule” “first filial piety and fraternal duty, the next respectful letter, there is a surplus of power, and learn the text”, therefore, the editor academic discussion of the post, welcome the domestic teachers and seniors criticism correction. At the invitation of the editor-in-chief of Clove Garden Orthopaedic Channel, Professor Sponseller P.D., Department of Orthopaedics, Johns Hopkins University School of Medicine, USA, in the same issue of JAMA 2003, I would like to present a review for the benefit of teachers and colleagues in China. Weinstein and other landmark reports help physicians to anticipate the future and lifelong effects of idiopathic scoliosis, a peculiar group of spinal disorders in which the deformity is, in some cases, obvious and, in those cases where the appearance is not, important. In fact, scholars such as Ponseti and Weinstein have been carefully following adolescent idiopathic scoliosis patients for 50 years and published several early studies (JBJS 1965, JBJS 1981, and JBJS 2000). This 2003 JAMA may be the last one, as the length and span of follow-up of this patient cohort (University of Iowa orthopaedic patients) has been so large. Previous studies of scoliosis reported a conflation of congenital, neuromuscular, and early-onset scoliosis, leading to the conclusion that the high causality of scoliosis was actually confounded by other factors. In this study, the researchers singled out the most common type of scoliosis, late-onset scoliosis (often referred to as adolescent idiopathic scoliosis, AIS), which usually develops after age 10 and is often genetic in origin. This patient cohort was diagnosed with adolescent idiopathic scoliosis at the University of Iowa in 1948 and earlier. In this study, the researchers went to great lengths in follow-up, and the average age of the patients was 66 years. The cohort excluded 58 of the original 444 patients who underwent spinal fusion. Researchers have previously reported that adolescent idiopathic scoliosis, which progresses slowly in adulthood (mean 23°) if the scoliosis is greater than 45° at skeletal maturity, has reduced pulmonary function in thoracic scoliosis and an increased risk of clinical presentation with shortness of breath in thoracic curves greater than 80°. In an analysis of the causes of death in 36 patients who died at the time of the researchers’ final follow-up in 1981, scoliosis caused 3 cases, and all 3 patients had scoliosis greater than 100°. In the 1981 JBJS report, there was also a case of a patient who died at the age of 54 years from chronic pulmonary heart disease originating from scoliosis. The patients’ lives were not greatly affected, and there was no difference in the number of marriages and children compared to controls. The vast majority were either homebound or working in middle age. Patients were the same as controls when tested on a scale for depression. However, back pain was more pronounced than in controls, although analgesics were rarely needed. Self-perceived disability, more patients than controls reduced work due to back pain, and decreased body satisfaction. There are several points to explore in this study. Of the original 444 patients, the cause of death was unknown in 20 of 69 patients who had died. In addition, 127 patients could not be contacted to obtain information. Therefore, comparisons of disease-related mortality in the patient cohort may be more accurate than comparisons of survival rates compared with the general population. On the other hand, the researchers reported 3 patients who committed suicide in 1969 and 1981, all with a chest curve of more than 70°. Moreover, the 117 patients in this study included patients with small degrees of scoliosis, some 15 to 20 degrees, and it is questionable whether patients with heavy scoliosis should be studied separately, since treatment is, after all, directed at this group of patients. The current treatment of scoliosis is diverse and can be basically summarized as follows: school screening for early prevention; brace therapy; and surgical fusion therapy for adolescent idiopathic scoliosis above 45° to prevent aggravation in adulthood. The vast majority of physicians prefer surgical treatment of thoracic curvature, especially above 60°, because of its impact on the lungs. In 1992, Lenke reported that modern scoliosis surgery to correct the deformity is effective and has a low complication rate, especially in adolescents. However, the study with a complication rate of 23.5%, cited by the editor in a previous post, comes from a multicenter study published in JBJS in April 2014 and reported by scholars at the Shriners Hospitals for Children in Philadelphia, USA (Hoashi JS .et al; Harms Study Group, Cahill PJ. Is there a “July effect” in surgery for adolescent idiopathic scoliosis? J Bone Joint Surg Am. 2014 Apr 2;96(7):e55, see editorial: July effect does not affect adolescent scoliosis surgery safety and outcomes). Moreover, Sponseller also noted that surgical treatment is expensive and that pain can occur in other segments of the spine after surgery (see Editor’s article: Thoracic flat back after scoliosis surgery is a risk factor for lumbar disc degeneration; excessive bleeding in adolescent scoliosis posterior fusion surgery is associated with more fused segments). So far, there is a lack of randomized clinical trial studies in scoliosis patients without treatment, compared with bracing or surgical treatment (editorial search on pubmed, enter adolescent idiopathic scoliosis AND randomized trials, 27 papers in the literature, 2008 US scholars, including the present study investigators Weinstein SL, “Preference assessment of recruitment into a randomized trial for adolescent idiopathic scoliosis”, mentions a study of this group of The willingness to observe randomized brace therapy in patients is problematic). This point is also worthy of study by our predecessors and colleagues in China, where a large population base and a large number of patients would benefit from a joint effort to conduct a multicenter, randomized clinical trial study to explore the true nature of adolescent idiopathic scoliosis treatment. The review concludes that the study by Weinstein et al. provides important information for advising patients and developing treatment plans that will help us to predict what is likely to happen to patients in the future. In adolescent idiopathic scoliosis patients with non-severe thoracic curvature, there is no increased risk of mortality. Patients with severe scoliosis with a chest curve greater than 80° may eventually develop shortness of breath or other pulmonary problems. Moderate to large scoliosis (45° or more) progresses slowly. Adolescents with idiopathic scoliosis, left untreated, have more back pain than the general population, but it is usually not disabling. Given that bracing and surgical treatment are not problem-free (not problem-free), patients may choose as they wish. Informing patients and parents of the natural course of the disease, the cost of treatment, and the risks, in full, will help to improve their ability to make informed choices. Finally, the editors would like to dedicate this weekend’s hard work to the patients and families of scoliosis and to the seniors, teachers, and colleagues in the domestic spine community, in the hope that scoliosis patients will be physically and mentally happy and that the spine community will obtain the best strategies for the treatment of adolescent idiopathic scoliosis as soon as possible.