I. Overview of idiopathic scoliosis/scoliosis
There are four physiological curves in the sagittal plane of the spine, and there should not be any curvature in the frontal plane; once the curvature appears to the sides, it is called scoliosis. Scoliosis is a clinical condition due to multiple etiologies and can be summarized into two main categories, namely functional scoliosis and structural scoliosis. Functional scoliosis, or compensatory scoliosis, has no internal structural damage to the spine. X-ray features: no damage to the spinal structure, the spine is only C-shaped bend. Structural scoliosis: the skeletal, muscular and neuropathic changes of the spine are caused.
A structural scoliosis of the spine with an unknown cause during growth and development is called idiopathic scoliosis. 60% to 80% of cases occur in girls. scoliosis is detectable in 2% to 3% of children aged 10 to 16 years. Scoliosis may first be suspected when one scapula seems higher than the other, or when clothing cannot be straightened, but is more often detected on physical examination. The earliest chief report may be weakness in the lower back after prolonged sitting or standing, followed by muscular back pain in areas of tension, such as the lumbosacral angle. Pain is uncommon in adolescent idiopathic scoliosis and therefore requires further examination.
Scoliosis with an unclear cause during growth and development is called idiopathic scoliosis. Idiopathic scoliosis is generally classified into three types based on age characteristics: early childhood (0-3 years), juvenile (4-9 years), and adolescent (10-16 years). Scoliosis is further classified according to the anatomical location where the parietal vertebrae are located.
1, cervical curvature: parietal vertebrae between C1-C6.
2, cervicothoracic bend: the parietal vertebrae are between C7 and T1.
3, thoracic curvature: the parietal vertebra is between T2-T11.
4, thoracolumbar curvature: parietal vertebrae between T12-L1.
5, lumbar bend: parietal vertebrae between L2-L4.
6, lumbosacral curvature: parietal vertebrae in L5 or S1.
Second, the etiology of adolescent idiopathic scoliosis/scoliosis?
Idiopathic scoliosis accounts for the majority of scoliosis, and it is important to understand its etiology in order to prevent and treat it. Therefore, for many years, the cause of idiopathic scoliosis has been explored, but the exact cause has not yet been identified.
In 1979, Herman demonstrated that patients with idiopathic scoliosis had impaired vagal function, and in 1984, Yamada also tested balance function in patients with idiopathic scoliosis and found that 79% had significant balance dysfunction compared to 5% of controls, and Wyatt also found significant vibratory imbalance in patients with scoliosis, suggesting a central disorder in the posterior column pathway in patients with scoliosis. However, these studies did not elucidate the relationship between idiopathic scoliosis and balance disorders, much less the etiology of idiopathic scoliosis itself.
The 1984 census showed the same results. The 1984 census also showed the same results, thus prompting an attempt to understand the relationship between growth hormone and idiopathic scoliosis. The results vary from author to author and growth hormone levels are still a matter of debate. More literature addresses the relationship between paravertebral muscles and idiopathic scoliosis, and tests of paravertebral muscles include: muscle shuttle, muscle fiber morphology, muscle biochemistry, myoelectricity, and calcium, copper, and zinc levels. Although abnormal findings have been made, none have directly elucidated their etiology. People have also investigated from familial, twin scoliosis patients regarding genetic issues, but more patients cannot yet be explained by a single genetic abnormality; therefore, the etiology of idiopathic scoliosis remains an important topic for future efforts to explore.
The pathogenesis of idiopathic scoliosis is unknown, and studies have found that it may be associated with the following factors.
(i) Genetic factors.
Epidemiological studies of idiopathic scoliosis suggest that there is a clear genetic influence on its occurrence, but the exact mode of inheritance is unknown. This seems to explain the sex characteristics of the disease distribution, where the ratio of males to females is approximately equal in patients with scoliosis around 20◦ ; however, in the scoliosis population larger than 20◦ , the ratio of females to males exceeds 5:1, and the majority of patients with severe curvature requiring treatment are girls. Statistically, children of two parents with scoliosis are 50 times more likely to have the disease than normal people.
(ii) Hormonal effects.
Girls with idiopathic scoliosis are often taller than normal girls of the same age, a phenomenon that suggests scoliosis may be related to growth hormones, but a large body of research suggests that growth hormones are not the true cause of spinal deformities. The control of growth is complex because growth requires the interaction of multiple factors, including growth factors.
(iii) Abnormalities of connective tissue development.
Patients with idiopathic scoliosis can be found to have qualitative and quantitative abnormalities of collagen and proteoglycans in the connective tissue. Whether this is a primary or secondary factor in scoliosis has not yet been determined.
(iv) Dysfunction of the neuro-balance system.
The function of the human balance system is to control the gravitational forces acting on the body and to maintain balance in various states. If there is a dysfunction in one of the reflexes of this balance system, scoliosis may occur in the spine to adjust or establish a new balance.
(v) Abnormalities of the neuroendocrine system.
Many scholars have shown that melatonin and 5-hydroxytryptamine play an important role in the formation of is. One of the classic animal models for scoliosis is the chicken model of scoliosis after pineal gland removal. The main role of the pineal gland is to secrete melatonin, so it has been hypothesized that a decrease in serum melatonin may be an important initiating factor in the development of scoliosis and is associated with the progression of scoliosis.
(vi) Others.
Some clinical observations have shown that offspring of older mothers are more susceptible to idiopathic scoliosis and progress more rapidly. In addition, abnormal copper metabolism may play a role in the development of idiopathic scoliosis.
Scoliosis has different etiologies and similar pathological changes, which are classified as reversible or irreversible according to the characteristics of the pathological changes. Reversible scoliosis generally occurs in functional (compensatory) postural scoliosis, commonly in the thoracic or thoracolumbar segments, mostly to the right and less to the left, with unilateral convexity predominating, apparent when standing or walking, disappearing when lying down or suspended, and showing a lateral convex arc on X-ray, with no change in bone structure. Irreversible scoliosis, generally refers to structural scoliosis. If treatment of reversible scoliosis is delayed, long-term soft tissue contracture on one side of the spine can also lead to structural changes in the spine (e.g., wedge-shaped changes in the vertebrae, thoracic deformities, etc.). The structural scoliosis deformity is more fixed and does not disappear or increase due to change in body odor, and is often combined with thoracic deformity, where the anterior thoracic wall is depressed and the posterior wall is elevated in scoliosis, and the anterior thoracic wall is depressed and the posterior wall is depressed on the concave side, with abnormal lung function. Scoliosis is combined with spinal rotation deformity, and scoliosis is combined with backward protrusion of the ribs to form a border ridge, which is called razorback deformity.
Third, the clinical manifestations of idiopathic scoliosis/scoliosis?
Clinical manifestations
1. Early childhood type
Idiopathic scoliosis/scoliosis
Early childhood-type scoliosis refers to structural scoliosis that occurs before the age of 3 years. Idiopathic scoliosis at this stage is relatively rare. It is characterized by more males than females, mostly left-sided convexity of the thoracic spine, and is often complicated by other deformities, most commonly tilt-head deformity, followed by mental retardation, or congenital hip dislocation. During the examination, the child is suspended from the armpit to observe the stiffness of the lateral convexity, and the neurological examination is performed to see if there is increased muscle tone or hypotonia, and to understand whether there are other congenital deformities, and to take front and side views of the full-length spine in the suspended and supine positions to observe the Cobb angle, Mehta’s sign, and the difference in rib angle. The so-called rib vertebral angle discrepancy refers to a line perpendicular to the end plate at the center of the parietal vertebrae of the thoracic bend, and then a median axis line at the head and neck of the corresponding ribs, and the angle of intersection of the two lines is the rib vertebral angle. In addition, Mehta describes two signs, namely, in the ortho-x-ray, the head of the rib in early childhood scoliosis does not overlap with the vertebral body, which is Mehta sign I. If the head of the rib on the convex side does not overlap with the vertebral body, the head of the rib on the concave side does not overlap with the vertebral body. If the head of the rib on the convex side overlaps the vertebral body, this is Mehta sign II. If the change from sign I to sign II indicates progression of the scoliosis, Mehta uses this sign and the difference in rib and vertebral angles to distinguish between recovered and progressed early childhood idiopathic scoliosis. This is a useful reference for predicting the prognosis of early childhood scoliosis.
2. Juvenile type
About 15% of idiopathic scoliosis is born after 3 years of age and before puberty. Koop (1988) reported that juvenile idiopathic scoliosis is mostly simple right-sided thoracic convexity, followed by bilateral convexity of the thoracolumbar segment.
3. Youthful type
Idiopathic scoliosis
Adolescence is a period of rapid skeletal growth and development, as well as a period of accelerated scoliosis progression. The Lonstein census reported that the incidence of scoliosis varies by age: 2.5% under 9 years, 4.1% at 10 years, 8.8% at 11 years, 19.8% at 12 years, 24.5% at 13 years, 19.5% at 14 years, and 19.5% at 15 years. 19.5%, and 20.8% for ages 15 and older. illustrates the relationship between age and development.
Lonstein’s opinion, based on the results of the 1970-1979 census, is that the progression of the scoliosis angle is positively correlated with the size of the original angle and inversely correlated with age and Risser’s sign, such that only 1.6% of those whose original scoliosis angle was less than 19° had a Risser’s sign of grade 2, 3, or 4 (or I, II, III, or IV degrees), while the other group with a scoliosis angle of 20°-29° had a Risser’s sign of grade 2, 3, or 4, and only 1.6% had progression. In the other group, the progression rate was as high as 68% with a lateral projection angle of 20°-29° and a Risser’s sign of grade 0 (unossified) or grade 1 (degree I). There is also a relationship between the Harringtonfactor and progression: the number of segments included in the scoliosis divided by the scoliosis angle. The mean value is 2.7 for the non-progressive type, and it is progressive if it exceeds 3.4. There is also a relationship between the type of scoliosis in a single factor. Bilateral convexity has a greater chance of progression than unilateral convexity, and bilateral bending of the mid-lumbar and thoracolumbar segments is more likely to occur than progression of thoracic segmental lateral convexity. Therefore, different treatment methods should be selected according to the patient’s different age, type of scoliosis, and different clinical manifestations.
IV. Diagnosis of idiopathic scoliosis/scoliosis in youth
(A) Medical history
1, Early detection: Scoliosis is first detected unintentionally by parents or teachers, and is manifested by unequal shoulders and unilateral scapulae protruding backwards.
2. Clinical symptoms: Curvature of the spine to one side is often the main symptom at the time of first diagnosis, in addition to trunk asymmetry when standing, such as unequal height of both shoulders, backward protrusion of one scapula, and asymmetry of the anterior chest. Severe scoliosis can lead to thoracic collapse, trunk imbalance, trunk shortening and decreased endurance due to decreased thoracic volume, shortness of breath, palpitations, etc. A few patients may experience low back pain. In some patients, scoliosis is unintentionally discovered and the deformity can be inconspicuous.
Family history: Although the relationship between ais and heredity has not yet been clarified, clinical observations have revealed that ais has a certain genetic predisposition. It is important to know the usual health status, intelligence level, and maternal history of pregnancy and childbirth to rule out non-idiopathic scoliosis. For example, knowing the patient’s birth history and history of polio can help distinguish between cerebral palsy caused by a difficult birth and scoliosis after polio.
4, Personal history: A detailed personal history can help determine the natural course of scoliosis, such as the age of onset and progression of scoliosis. Most idiopathic scoliosis develops during adolescent development and progresses rapidly during the rapid growth period. Neuromuscular scoliosis can develop at any age.
(ii) Physical examination
The anterior flexion test is an important test for idiopathic scoliosis, in which the patient is asked to stand with the feet together, knees straight, waist flexed forward, hands together, and arms down, and the doctor observes from the front, back, and sides of the patient to see if the back is high on one side, low on the other side, and posterior or anterior convexity deformity. The angle of asymmetry is measured with a scoliosis ruler, and if it is at 5-7o, the cobb angle on the x-line is at 15-20o. The patient can be checked for tilt of the trunk in the standing position to determine the flexibility of the spine, and the shoulders and both sides of the iliac spine need to be checked for equal height. When there is back pain present, the site of pain should be checked.
2. Detailed neurological examination, carefully check whether there are abnormalities in sensation, movement, muscle strength, muscle tone and reflexes, and whether there is weakening, disappearance and asymmetry of abdominal wall reflexes and pathological signs. The skin is examined for milk coffee spots, excessive laxity of the skin and joints, and signs of marfan’s syndrome. It helps to exclude non-idiopathic scoliosis such as: congenital scoliosis, cerebral palsy, poliomyelitis, spina bifida, neurofibromatosis, marfan’s syndrome, ehlers-danlos syndrome, chiari malformation and other causes of scoliosis.
(iii) Imaging
Radiographs are the primary means of diagnosing and evaluating adolescent idiopathic scoliosis. The type, location, severity and flexibility of scoliosis can be determined, which helps to determine the etiology and perform preoperative design.
The x-ray features of adolescent idiopathic scoliosis show the following.
(1) No changes in the bony structure of the spine: a few early scoliosis may have mild wedge-shaped changes in the parietal vertebrae.
(2) The curvature of scoliosis is uniformly altered, without short or sharp arcs.
(3) There is a certain amount of uniformly varying flexibility, and the flexibility increases gradually from the parietal to the terminal vertebrae.
(4) Scoliosis is more common in the thoracic spine with right-sided convexity, and the possibility of non-specific scoliosis should be considered if left-sided convexity is present.
(5) Idiopathic scoliosis is mostly manifested in the sagittal plane as a reduction or loss of physiological lordosis of the thoracic spine.
(6) In idiopathic scoliosis, the anterior column (i.e., vertebral body) is mostly shifted to the convex side, while the posterior column (spinous process) is shifted to the concave side; if the rotation direction is opposite, tumor or other causes of scoliosis should be excluded.
The x-ray plain film requirement is a standing posterior anterior full spine film from thoracic 1 to sacral 1, with lateral and bending films required for surgery. The cobb method is often used to measure the angle of scoliosis in the coronal plane by first identifying the upper and lower end vertebrae of scoliosis on the orthopantomograph, which are most heavily tilted throughout the bending, and drawing a straight line along the upper end plate of the upper end vertebrae and the lower end plate of the lower end vertebrae, with the angle of intersection of the two perpendicular lines being the cobb angle of scoliosis. Evaluation of skeletal maturity is important in predicting the progression of scoliosis and deciding on treatment measures, and is most often estimated using the skeletal epiphysis, i.e., risser. ossification gradually moves from the anterior superior iliac crest to the posterior superior iliac crest, dividing the iliac crest into quadrants, with the epiphysis moving 25% for level i; 50% for level, 75% for level, and moving to the posterior superior iliac crest for level n. The fusion of the epiphysis with the iliac bone is level v, at which point the marker bone iliac The development of the system stops.
Idiopathic scoliosis generally does not require CT and MRI. For “atypical” idiopathic scoliosis, such as left-sided thoracic convexity with local sensory or motor deficits, abnormal abdominal wall reflexes, positive pathological reflexes, and abnormal skin manifestations, mri can exclude intradural lesions such as spinal cavity, chiari malformation, spinal cord embolism, and spinal longitudinal fracture.
V. Treatment options for youth idiopathic scoliosis/scoliosis
Treatment options
In functional scoliosis, prevention is the main focus. School-age children should maintain correct posture and strengthen the lumbar and back muscles, abdominal muscles, iliac muscles and shoulder muscles, which are self-correcting in mild cases and do not require treatment. Idiopathic scoliosis, without structural abnormalities, can be prevented by wearing a brace or a short jacket with a spiral to prevent the development of the deformity. The deformity tends to worsen when the affected person reaches the age of 12-16 years, which is the adolescent growth period, and should be closely observed and effective treatment measures should be actively taken.
Surgical treatment for structural abnormalities of the spine (such as congenital hemivertebral body, spinal cord longitudinal fracture, cervical ribs, and parallel ribs), pathological changes in spinal structures (such as tuberculosis, tumors, etc.) and various tissue deformities outside the spine, such as thoracic contouring and burn scars, should be actively treated to eliminate these pathological changes and structural deformities outside the spine and to lay a good foundation for the correction of scoliosis deformity.
Surgical methods for correction of scoliosis include
(1) Special corrective instrumentation: Harrington instrumentation, including a brace and a compression bar.
(2) Spinal fusion: cancellous bone is implanted next to the spinous process. Sometimes both methods are used together.
1.Toddler type
First of all, the treatment plan should be made according to the X-ray film. If the X-ray film shows the first stage of Mehta’s sign, the difference of rib angle is less than 20 degrees for the recovery type, which usually does not need treatment. However, the X-ray film should be reviewed once every six months for follow-up examination until complete recovery. In the future, the X-ray will be reviewed every 1-2 years until the skeletal development is mature. If the radiographs show Mehta’s sign as the second stage and the difference in rib angle is greater than 20°, early treatment is indicated. Orthopedic plaster undershirt fixation under anesthesia may be considered, and the patient may be treated with Milwaukee brace fixation as he grows older. If the brace does not control its progression, subcutaneous support internal fixation without fusion may be considered. Unless a rigid scoliosis that cannot be controlled by conservative methods is a last resort, spinal fusion is considered.
2. Juvenile type
The incidence of idiopathic scoliosis in both sexes varies with the age of the patient. However, most scholars believe that the juvenile type is more common in women than in men, and most believe that right-sided convexity of the thoracic curve is more common. Treatment of juvenile idiopathic scoliosis is more widely indicated than treatment of adolescent scoliosis because there is a tendency for scoliosis to worsen in juveniles. Physical therapy is feasible for scoliosis below 20°. Standing films are taken every 6 months for follow-up. Patients with 20°-40° thoracic curvature and double curvature should be given a Milwaukee brace, and in case of thoracolumbar or lumbar curvature should be treated with a thoracolumbosacral brace. If brace treatment does not control its development and the lateral bend angle is greater than 40°, but the lateral bend is soft and more flexible, subcutaneous rod support correction can be used. If the scoliosis is stiff and poorly flexible, or if the scoliosis continues to worsen and the Cobb angle cannot be controlled to within 50°, either with brace treatment or subcutaneous rod support, then spinal fusion should be considered. Otherwise, treatment should be as conservative as possible until the age of fusion.
3. Youthful type
Adolescent idiopathic scoliosis is the most common form of scoliosis and is more common in women than in men, with the right side of the thoracic curve being the most common. The most important aspect of treatment for adolescent scoliosis is to evaluate the patient’s developmental period according to the Risser sign. Patients who are under 20° of developmental maturity may not be treated. If the patient is immature, physical therapy is available and the patient will be followed up with radiographs every six months until maturity. If the scoliosis is more than 25° and the growth is not mature, Milwaukee brace or thoracolumbosacral brace should be given as soon as possible, together with physical therapy or electrical stimulation, until the whole spine stops growing and the risser’s sign is grade 4 (IV) or higher, then the brace should be removed. For adolescent scoliosis with a Cobb’s angle of 40° or more that is still growing, conservative treatment should not be used, but direct spinal orthopedic fixation and fusion should be performed, generally with the Harrington apparatus being the most commonly used.
For adult patients who develop scoliosis before skeletal maturity and are seen in adulthood, some authors point out that those with a thoracic bend angle in the range of 50°-80° still have the possibility of progression, whereas those with a scoliosis of 50° or greater than 80° are less likely to progress, and advocate surgical fusion for progressive thoracic scoliosis after skeletal maturity, if the angle reaches 50°. If the angle of scoliosis in the thoracolumbar segment exceeds 50°, surgical treatment can also be considered to prevent back pain. In conclusion, the treatment of idiopathic scoliosis should be based on the patient’s age and the type of scoliosis, etc. The appropriate treatment method should be chosen.
VI. Conservative treatment of idiopathic scoliosis/scoliosis in young people?
Non-surgical treatment includes physical therapy, body therapy, surface electrical stimulation, casts and braces. However, the main and most reliable method is bracing.
Indications for brace treatment.
1, mild scoliosis between 20 and 40 degrees, scoliosis more than 40 degrees is not suitable for brace treatment.
2. Children with immature bone pathways should be treated with bracing.
3, two structural curvatures to 50 degrees or a single curvature of more than 45 degrees should not be treated with braces
4.Scoliosis with combined thoracic anterior convexity should not be treated with bracing.
5.Segmental long curvature, brace treatment is good, and scoliosis of lumbar segment or thoracolumbar segment with better elasticity below 40 degrees.
7. Brace treatment is not recommended for patients and uncooperative parents.
Brace Wearing
When the brace is started, it should be worn for 23 hours a day, and one hour should be used for physical therapy, breathing exercises, etc. If the cooperation of the patient and family cannot be obtained, the brace should be worn for at least 16 hours a day. If the Cobb angle can be reduced by 50% after wearing the brace, a better treatment effect can be expected. After one year of treatment, if the scoliosis can be reduced by 50%, the wearing time can be gradually reduced and, with the increase of Risser, the brace can be worn only at night. If the scoliosis starts to increase by more than 5 degrees, the wearing time should be increased again.
VII. What is the surgical treatment of idiopathic scoliosis/scoliosis in youth?
The aim of surgical treatment is to stop the further development of the deformity by fusing the spine so that the impact of the deformity on the body is minimized. On this basis, a certain degree of orthosis and promotion of bone fusion is done with the use of instruments; orthosis is not the main purpose.
Indications.
1. The development of the deformity cannot be controlled by brace treatment and the degree of scoliosis continues to increase.
2. Pulmonary dysfunction and trunk asymmetry in adolescent scoliosis, where the deformity is severe enough to require orthopedic treatment.
3. Older patients with pain or neurological symptoms that cannot be controlled by conservative treatment.
4. Adolescent scoliosis of 45 degrees or more.
5. Cobb’s angle of 40 degrees, but with severe anterior chest convexity and significant rib augmentation.
Surgical treatment should take active measures to adequately treat structural abnormalities of the spine (such as congenital hemivertebrae, longitudinal spinal bifida, cervical ribs, and parallel ribs), pathological changes in spinal structures (such as tuberculosis and tumors) and various tissue deformities outside the spine, such as thoracoplasty and burn scars, in order to eliminate these pathological changes and structural deformities outside the spine and lay a good foundation for correcting scoliosis deformity.
Surgical methods for correction of scoliosis include
(1) Special corrective instrumentation: Harrington instrumentation, including a spacer and a compression bar.
(2) Spinal fusion: cancellous bone is implanted next to the spinous process. Sometimes both methods are used together.
1.Toddler type
First of all, the treatment plan should be made according to the X-ray film. If the X-ray film shows the first stage of Mehta’s sign, the difference of rib angle is less than 20 degrees for the recovery type, which usually does not need treatment. However, the X-ray film should be reviewed once every six months for follow-up examination until complete recovery. In the future, the X-ray will be reviewed every 1-2 years until the skeletal development is mature. If the radiographs show Mehta’s sign as the second stage and the difference in rib angle is greater than 20°, early treatment is indicated. Orthopedic plaster undershirt fixation under anesthesia may be considered, and the patient may be treated with Milwaukee brace fixation as he grows older. If the brace does not control its progression, subcutaneous support internal fixation without fusion may be considered. Unless a rigid scoliosis that cannot be controlled by conservative methods is a last resort, spinal fusion is considered.
2. Juvenile type
The incidence of idiopathic scoliosis in both sexes varies with the age of the patient. However, most scholars believe that the juvenile type is more common in women than in men, and most believe that right-sided convexity of the thoracic curve is more common. Treatment of juvenile idiopathic scoliosis is more widely indicated than treatment of adolescent scoliosis because there is a tendency for scoliosis to worsen in juveniles. Physical therapy is feasible for scoliosis below 20°. Standing films are taken every 6 months for follow-up. Patients with 20°-40° thoracic curvature and double curvature should be given a Milwaukee brace, and in case of thoracolumbar or lumbar curvature should be treated with a thoracolumbosacral brace. If brace treatment does not control its development and the lateral bend angle is greater than 40°, but the lateral bend is soft and more flexible, subcutaneous rod support correction can be used. If the scoliosis is stiff and poorly flexible, or if the scoliosis continues to worsen and the Cobb angle cannot be controlled to within 50°, either with brace treatment or subcutaneous rod support, then spinal fusion should be considered. Otherwise, treatment should be as conservative as possible until the age of fusion.
3. Youthful type
Adolescent idiopathic scoliosis is the most common form of scoliosis and is more common in women than in men, with the right side of the thoracic curve being the most common. The most important aspect of treatment for adolescent scoliosis is to evaluate the patient’s developmental period according to the Risser sign. Patients who are under 20° of developmental maturity may not be treated. If the patient is immature, physical therapy is available and the patient will be followed up with radiographs every six months until maturity. If the scoliosis is more than 25° and the growth is not mature, Milwaukee brace or thoracolumbosacral brace should be given as soon as possible, together with physical therapy or electrical stimulation, until the whole spine stops growing and the risser’s sign is grade 4 (IV) or higher, then the brace should be removed. For adolescent scoliosis with a Cobb’s angle of 40° or more that is still growing, conservative treatment should not be used, but direct spinal orthopedic fixation and fusion should be performed, generally with the Harrington apparatus being the most commonly used.
For adult patients who develop scoliosis before skeletal maturity and are seen in adulthood, some authors point out that those with a thoracic bend angle in the range of 50°-80° still have the possibility of progression, whereas those with a scoliosis of 50° or greater than 80° are less likely to progress, and advocate surgical fusion for progressive thoracic scoliosis after skeletal maturity, if the angle reaches 50°. If the angle of scoliosis in the thoracolumbar segment exceeds 50°, surgical treatment can also be considered to prevent back pain. In conclusion, the treatment of idiopathic scoliosis should be based on the patient’s different age and type of scoliosis, etc. The appropriate treatment should be selected.