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Adolescent idiopathic scoliosis (AIS) affects 1-3% of children in the at-risk population of those aged 10-16 years. The aetiopathogensis of this disorder remains unknown, with misinformation about its natural history. Non-surgical treatments are aimed to reduce the number of operations by preventing curve progression. Although bracing and physiotherapy are common treatments in much of the world, their effectiveness has never been rigorously assessed. Technological advances have much improved the ability of surgeons to safely correct the deformity while maintaining sagittal and coronal balance. However, we do not have long-term results of these changing surgical treatments. Much has yet to be learned about the general health, quality of life, and self-image of both treated and untreated patients with AIS.

Conclusion

Although many controversies and unanswered questions surround AIS, the most difficult one is the absence of information about its aetiopathogenesis. We do not know if AIS is one entity or a manifestation of several causes. We are uncertain of all the factors that lead to progression and secondary manifestations of spinal deformity. The identification of aetiopathogenetic factors will enable improved prediction of progression and could aid in the development of more specific treatments.

Because of this absence of fundamental information, all treatment efforts are aimed at prevention or correction of the primary manifestation of the disorder-ie, spinal deformity. Although bracing has been regarded as the standard of care for patients at a high risk of progression (curves between 25° and 40° in skeletally immature patients), it has never been subjected to rigorous assessment of either its efficacy or effectiveness. Both the North American and Netherlands' clinical trials are addressing quality of life and other psychosocial issues in individuals with AIS. If these studies show undue stress resulting from observation alone or brace treatment, this stress should be considered in the decision-to-treat equation.

With respect to surgical management, although technology has greatly increased the safety with which we can correct spinal deformity and preserve spinal balance, long-term results of these changing methods of management are absent. Surgery can reduce deformity and prevent further progression; thereby decreasing the risk of future cardiopulmonary compromise, but its role in the prevention of other negative long-term effects of scoliosis is not clear.