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Scoliosis

Original Editor - Gregory Maes Top Contributors - Lucas De Bondt, Amrita Patro, Kristen Holeman, Lydia Xenou, Gregory Maes, Lucinda hampton, Kim Jackson, Nikhil Benhur Abburi, Vidya Acharya, Admin, Selena Horner, Lieselot Longe, Oyemi Sillo, Ellen De Boitselier, Evan Thomas, 127.0.0.1, Aminat Abolade, WikiSysop, Laure VanderDonckt, Jason Coldwell, Liese Bosman, Linde Van Droogenbroeck, Tarina van der Stockt, Ginika Jemeni, Blessed Denzel Vhudzijena, Ahmed Ezzat, Alexandra Stead, Ellen Hopmans, Derycker Andries, Ewa Jaraczewska and Scott Buxton


Introduction

scoliosis clinical presentation
Anatomy of scoliosis

Scoliosis is an abnormal lateral curvature of the spine, diagnosed when the Cobb angle on standing radiograph exceeds 10°. It is most commonly identified in late childhood or early adolescence, between the ages of 10 and 15 years, coinciding with periods of rapid skeletal growth.[1][2]

Scoliosis may be classified as structural, involving a fixed, three-dimensional deformity of the spine and trunk, or functional (non-structural), where the curve is secondary to an underlying cause such as leg length discrepancy or muscle imbalance and resolves when the causative factor is addressed.[3]

Structural scoliosis is further classified by aetiology into idiopathic, congenital, and neuromuscular forms, with idiopathic scoliosis accounting for approximately 75–85% of all cases.[4] The severity of the deformity is determined by the Cobb angle, with management ranging from observation and physiotherapy to bracing and surgical intervention depending on curve magnitude and skeletal maturity.[5]

Clinically Relevant Anatomy

Vertebral Column Structure

The vertebral column normally consists of 33 vertebrae: 24 mobile vertebrae in the cervical, thoracic, and lumbar regions, plus 5 fused vertebrae forming the sacrum and typically 4 fused vertebrae forming the coccyx.[6]

Spinal anatomy showing regions of the spine
Regions of the spine

Variations can occur such as hemi-vertebrae and fused vertebrae.

Spinal Curves

When viewed from the side, the vertebral column displays four curves in the upright posture. These curves are categorised as primary curves, developed during foetal development, and secondary curves, developed after birth when the individual learns to sit, stand and walk.[6][7]

Primary Curve
  • Thoracic curve

The thoracic curve is concave anteriorly (kyphotic), extending from T2-T12, and results primarily from the wedge shape of the thoracic vertebral bodies.[6] A slight lateral deviation may be present in the upper thoracic spine as a normal anatomical variant, distinct from pathological scoliosis.[7]

  • Sacrococcygeal curve

Extends from the lumbosacral junction through the sacrum to the coccyx; concave anteriorly (kyphotic).[6]

Secondary Curves:
  • Cervical curve

The cervical curve is convex anteriorly (lordotic) extending from the axis (C2) to the T2 vertebra.[6]

  • Lumbar curve

The lumbar curve is convex anteriorly (lordotic) and extends from L1 to the lumbosacral junction. [6]

Types of Scoliosis

There are two types of scoliosis: Structural and Functional.

Structural Scoliosis

In a typical spine, three anatomical curves exist in the sagittal plane: lordosis at the cervical and lumbar regions, and kyphosis at the thoracic region. These curves are essential for load distribution, shock absorption, and maintaining the head over the pelvis.[7] Structural scoliosis is defined simply as a curvature of the spine in the coronal/frontal plane. The more complex definition of scoliosis includes a three-dimensional (3D) deformation of the spine and trunk in all anatomical planes including:[8][9]

  • Coronal/Frontal plane: lateral curvature, measured as the Cobb angle
  • Sagittal plane: typically associated with hypokyphosis in thoracic curves
  • Axial/Transverse plane: vertebral rotation, contributing to the rib hump

The severity of the diagnosis is determined by the Cobb angle of the spinal curvature in the coronal plane typically accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane.[7][8][9]

Scoliosis can progress during periods of rapid skeletal growth, with multiple patient-specific and radiological factors influencing the rate of progression.[10]

As the curve progresses, the rotational component becomes more pronounced, leading to a rib hump – a visible posterior prominence on the convex side.[9]

Functional Scoliosis

Functional scoliosis, also called unstructured or non-structural scoliosis, is a mild curvature without any structural abnormality of the vertebrae, leading to no rotational deformity of the spine. The functional scoliosis is often secondary to limb length discrepancy (LLD), muscle imbalances/spasms or poor posture.[3]

Epidemiology

The following summarises the key epidemiological characteristics of scoliosis in the global population.

  • The prevalence of scoliosis in the general population is around 2%-3%.[11]
  • Whilst scoliosis most commonly presents in adolescence, it may also develop in adults, often due to degenerative spinal changes.[12]
  • Idiopathic scoliosis is the most prevalent form, accounting for approximately 75-85% of all cases.[4]
  • The female-to-male ratio ranges from 1.5:1 to 3:1 and increases substantially with increasing age.[4]
  • The prevalence of curves with higher Cobb angles is substantially higher in girls than in boys: The female-to-male ratio rises from 1.4:1 in curves from 10-20° up to 7.2:1 in curves >40°.[4]
  • Peak prevalence occurs between ages 10 and 15 years, coinciding with adolescent growth spurts, with prevalence in adolescents nearly four times higher than in younger children.[1] [2][4]

Aetiology

Scoliosis can be classified by aetiology into several types, the most common of which are idiopathic, congenital, and neuromuscular. Other forms include degenerative scoliosis in adults and scoliosis associated with syndromic conditions.[12]

Idiopathic scoliosis

  • Idiopathic scoliosis has no identified underlying cause, and its aetiology is believed to be multifactorial, involving genetic, hormonal, and biomechanical factors.[11]
  • Adult scoliosis has a prevalence of more than 8% in adults over the age of 25 and rises to 68% in the age of over 50 years, and a prevalence of 2-32% in the general population with a Cobb angle larger than 10 degrees.[12]

Idiopathic scoliosis is further classified into the following age-based subgroups:

  1. Infantile scoliosis: Infantile scoliosis develops at the age of 0-3 years and shows a prevalence of 1% compared to all idiopathic scoliosis.[1][13][14]
  2. Juvenile scoliosis: Juvenile scoliosis develops at the age of 3-10 years, comprises 10-20% of all idiopathic scoliosis in children.[13][14]
  3. Adolescent scoliosis: Adolescent scoliosis develops at the age of 10-18 years, and accounts for approximately 90% of cases of idiopathic scoliosis in children.[1]

Congenital scoliosis

  • Congenital scoliosis occurs in approximately 0.5 –1.0 per 1000 births.[15]
  • It encompasses a wide spectrum of anomalies that arise from failures in vertebral formation or segmentation, or mixed defects during the fourth to sixth weeks of gestation.[14]
  • Although the vertebral anomaly occurs very early in the foetal development in utero, the deformity of the spine progresses as the child grows, leading to diagnosis.[14]
  • Congenital scoliosis is commonly diagnosed during the infant or toddler period; however, diagnosis may occur as late as the child’s adolescent years.[14]

Neuromuscular scoliosis

  • Neuromuscular scoliosis is an abnormal lateral curvature of the spine secondary to disorders of the brain, spinal cord, or muscular system.[14]

Characteristics/Clinical Presentation

Scoliosis clinical presentation incl. x-ray
Scoliosis clinical presentation incl. x-ray

There are several signs that may indicate the possibility of scoliosis.[14]

  • Head does not appear centred, with possible tilting to one side
  • One hip shifted higher than the other
  • Rib cage appears uneven, with one side more prominent than the other; a rib hump may be visible on forward flexion
  • Scapular winging on one side
  • Evident leaning to one side compared to the other side
  • One leg seems longer than the other
  • Paraspinal muscle asymmetry or tenderness

One study found that approximately 58.8% of children aged 11–18 with idiopathic scoliosis presented with back pain, compared with a 33% prevalence in children without scoliosis.[16] Ten percent of these patients were found to have an underlying associated condition such as spondylolisthesis, syringomyelia, tethered cord, herniated disc, or spinal tumour.[16] If a patient with diagnosed idiopathic scoliosis has more than mild back discomfort, a thorough evaluation for another cause of pain is advised.

Beyond musculoskeletal symptoms, changes in thoracic shape and size in idiopathic scoliosis may affect pulmonary function, with studies showing diminished function even in mild to moderate cases. Impairment of function was seen in more severe cases of spinal deformity, proximally located curvature, and older patients.[17]

Diagnosis

  • Initial clinical assessment typically involves the Adams Forward Bend Test which is widely recognised as the primary first-line screening tool for the early detection of scoliotic deformities.[18] This is commonly performed by paediatricians and at school screenings.
  • A scoliometer is used to measure the angle of trunk rotation (ATR), with a threshold of ≥7° typically indicating referral for radiological assessment.[19]
  • The posteroanterior (PA) standing radiograph is the gold standard for diagnosis, with the Cobb angle serving as the internationally accepted measure of curve severity.[20][18]
  • Technological advancements have led to the development and validation of 3D markerless surface topography (ST) systems, enabling the assessment of trunk asymmetry, spinal contour, and surface rotation parameters without exposing patients to ionising radiation.[18]
  • MRI of the spine is indicated when neurological symptoms are present or when intraspinal pathology is suspected, including syringomyelia, tethered cord, or spinal tumour.[17]

Outcome Measures

Several different outcome measures have been evaluated in the efficacy of scoliosis assessment. Evaluation of scoliosis treatment should include the patients’ perspective, obtained with the use of patient-reported outcome measures (PROM).

  • Generic measures to assess health-related quality of life (HRQL) include SF-36 questionnaire and the EuroQol5D instrument.[21][22]
  • Scoliosis specific questionnaires include SRS-22 Patient Questionnaire and the Quality of Life Profile for Spinal Deformities (QLPSD).[21]
  • Instruments available to evaluate patients' perception of their trunk deformity and body image include the Walter-Reed Visual Assessment Scale (WRVAS), the Spinal Appearance Questionnaire (SAQ), and the Trunk Appearance Perception Scale (TAPS).[21][23]
  • The impacts of the brace use can be measured with specific scales: Bad Sobernheim Stress Questionnaire (BSSQ) and Brace Questionnaire (BrQ).[21]

The above instruments have not been validated or analysed to evaluate the treatment for non-idiopathic scoliosis.[21]

Examination

The aim of the functional examination is to distinguish between non-structural (postural) scoliosis and structural idiopathic scoliosis.[18][19]

Adam Forward Bend test illustration
Adams forward bend test

Examination of the active movements (flexion, extension, and side flexion) of the spine in the cervical, thoracic, and lumbar segments.[19][5]

The Adam forward bend test can be used to make a distinction between structural scoliosis or non-structural scoliosis of the cervical to lumbar spine. The test can be performed in the standing and sitting position.[19]

The Cobb angle is a standard measurement to determine and track the progression of scoliosis.[20][18]The curvature is measured on a standard AP x-ray in the standing position, with the measurement taken from the upper end vertebra to the lower end vertebra which is essentially where the curve begins and ends. When this angle of curvature is >10°, it is indicative of scoliosis.[24]

The Scoliometer is an inclinometer designed to measure trunk asymmetry or axial trunk rotation. It’s used at three areas:

  • Cobb angle illustration
    Cobb angle of measurement for scoliosis
    Upper thoracic (T3-T4)
  • Middle thoracic (T5-T12)
  • Thoraco-lumbar area (T12-L1 or L2-L3)

If the measurement is equal to 0°, there is a symmetry at the particular level of the trunk. An asymmetry at the particular level of the trunk is found if the scoliometer measurement is equal to any other value with a threshold of ≥7° angle of trunk rotation (ATR) considered clinically significant and indicative of referral for radiological assessment.[19][5] [25]

Pulmonary function testing is useful in the preoperative evaluation of patients.[26] Spirometry is the most commonly used pulmonary function test in scoliosis, assessing both lung volume and airflow:

  • FVC gives an assessment of lung volume
  • FEV1 provides an assessment of flow function.

Medical Management

The Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) has developed 2016 guidelines for standardised treatment of scoliosis based on the current evidence on conservative treatment of idiopathic scoliosis (CTIS). High-quality evidence has emerged in the areas of efficacy of bracing and physiotherapeutic scoliosis-specific exercises (PSSE).[5]

Medical management is classified according to the patient’s Cobb angle, skeletal maturity or Risser Score and classification of idiopathic scoliosis with treatment ranging from:

  • Observation: curves <25° in skeletally immature patients[5]
  • Bracing: indicated for curves 25-45° in skeletally immature patients[5]
  • PSSE: Schroth method and other approaches[5]
  • Surgery: indicated for curves >45-50°[5]

Conservative Treatment

Common management for patients with mild-moderate scoliosis includes conservative interventions. Conservative treatment typically consists of bracing, physiotherapy, or a combination of the two.[27] Depending on the patient’s age and Cobb angle, consistent follow ups with their medical provider are necessary to monitor any changes in the curvature of the spine as they age.[5]

Goals for conservative treatment of scoliosis, according to the 2016 SOSORT guidelines are:[5]

  1. To stop curve progression at puberty (or possibly reduce it)
  2. To prevent or treat respiratory dysfunction
  3. To prevent or treat spinal pain syndromes
  4. To improve aesthetic via postural correction

Braces

During adolescence, it is common for the treating clinician or orthopaedic specialist to recommend bracing in order to halt curve progression. The literature agrees that when a child is still growing and has a documented progressive curve between 20-45°, a well-designed and adapted brace providing a correction of 50% can stop the curve’s progression in many cases.[28]

Indications for brace treatment include:

  • Patients with a curve of 25-40° still growing child[28]
  • Patients with curves <25° and a documented progression of 5-10° in six months (progression of more than 1° per month)[28]
  • Patients with scoliosis of 20-25° with pronounced skeletal immaturity (Risser 0, Tanner 1 or 2) should also be treated immediately[28]

Braces are generally worn full time (20-24 hours) but can vary from night-time wear (8-12 hours) or part-time bracing (12-20 hours). 23 Overall, brace compliance is a key determinant of treatment success, with greater daily wear time associated with improved curve control.[5][28]

Boston brace

The most recommended braces are made of plastic and are contoured to conform to the body, created specifically for the patient based on their curve pattern by a licensed orthotist. There are several different types of braces with the most widely recognized including the Milwaukee Brace, Boston brace, Lyon brace, Chêneau brace, Rigo Chêneau brace, and many more.[28][29]

Bracing is discontinued when growth stops by monitoring the patient's Risser Sign for skeletal maturity.[28]This typically occurs:

  • At Risser 3 in females, typically 18 months after menarche[28]
  • At Risser 4 in males[28]
  • Weaning is performed in a period of 6 months[28]

There is minimal evidence regarding bracing in neuromuscular scoliosis. It has been noted that bracing may be more difficult in neuromuscular scoliosis and less well tolerated by patients, as well as no evidence that it reduces risk of curve progression with additional benefits.[30]

In regard to congenital scoliosis, the purpose of bracing is to delay the surgical interventions and decrease the number of recurrent surgical procedures. It has been determined that bracing is a safe and effective time-buying strategy, delaying surgical interventions for congenital scoliosis.[31]

Physical Therapy Management

As reported by SOSORT Guidelines of 2016, physical therapy and bracing are commonly used in unison to treat mild to moderate forms of scoliosis to maintain cosmesis and avoid surgery.[5]  With studies revealing that scoliosis is not just a lateral curvature of the spine, but a 3D condition, many different physical therapy programs use this understanding for performance of Physiotherapeutic Scoliosis-Specific Exercises (PSSE), which is the most studied physiotherapy treatment for scoliosis.[5] This addresses management of scoliosis in all three planes: sagittal, front, and transverse.

Physical therapy is highly recommended for patients with scoliosis due to:

  • Specific curative effect
  • Strong patient adherence
  • Ease of implementation
  • Minimal side effects
  • Cost-effectiveness[5]

Research has demonstrated that exercise therapy can decelerate scoliosis progression, improve the muscular control of spine and improve cardiopulmonary function, as well as helping address psychological issues such as depression and anxiety.[32]

Physiotherapeutic Scoliosis Specific Exercise (PSSE) Programs

Physiotherapeutic scoliosis-specific exercise programs have been agreed to consistent demonstrate the following principles:[5]

  • Auto-correction in 3D
  • Training in activities of daily living (ADL)
  • Stabilizing the corrected posture
  • Patient education

The SOSORT 2016 guidelines report additional positive outcomes from PSSE including improved neuromotor control, respiratory function, back muscle strength, and cosmetic appearance.[5]

Schroth Method

The Schroth Method is one of the most well-known, non-surgical option for scoliosis treatment. It was developed in 1920 by Katarina Schroth to treat her own moderate scoliosis. This method uses exercises customised for each patient to return the curved spine to a more natural position. The principles of active 3D posture correction, corrective breathing, and correction of postural perception form the foundation for what came to be known as the Schroth method of scoliosis treatment. Goals for treatment through the Schroth Method include:[33]

Schroth method illustration
Semi-hanging Schroth technique
  • Proactive spinal corrections to avoid surgery
  • Postural training to avoid or decelerate progression
  • Information to support a decision-making process
  • Teaching a home-exercise program
  • Support help for self-help
  • Prevention and coping strategies for pain

There are five principles of the Schroth method which include: 1. Auto-elongation (detorsion); 2. Deflection; 3. Derotation; 4. Rotational breathing; and 5. Stabilization.[33]

[34]

Scientific Exercises Approach to Scoliosis (SEAS)

The Scientific Exercise Approach to Scoliosis (SEAS) is a modern, evidence-based physiotherapeutic approach for the conservative treatment of idiopathic scoliosis. Developed in Italy in the early 1960s, focusing on regaining postural control and improving spinal stability through exercises involving active 3D self-correction of the scoliotic posture. The active 3D self-correction technique utilized by SEAS includes the following steps:[33]

  1. SEAS mobilization and flexibility exercises of the spine to improve joint mobility for better posture correction
    Patient education regarding their specific spinal deformity
  2. Active self-correction of posture
  3. Spinal stabilization through postural maintenance through a variety of exercises
  4. Exercises are progressed to incorporate daily life activities to include neuromuscular integration

The hallmark feature of the SEAS method is the “team approach” of the program. SEAS aims to ensure cohesive involvement of the physician, the physical therapist, the orthotist, and the patient’s family. This teamwork demonstrates improvement of patient compliance with exercises, leading to an improved outcome.[33]

SEAS belongs to the family of Physiotherapeutic Specific Scoliosis Exercises (PSSE), similar to the Schroth method, designed to actively manage scoliosis through individualised, curve-specific training.

[35]
[36]
Other PSSE Programs:

There are several different PSSE programs with research to support positive outcomes with consistent performance. These include Lyons method, Barcelona scoliosis physical therapy school (BSPTS), The Dobomed method, Side shift, Klapp exercises and several others. [33]

Breathing Exercises

Pulmonary function is important factor in scoliosis management, as the curvature of the spine can impact respiratory mechanics. [Muscle Training|Breathing exercises] combined with the thoracic active mobilisations are another physiotherapy treatment available for scoliosis.[37] A scoliotic curve can affect a person’s breathing which can lead to:

  • Restrictive lung disease through multiple mechanisms, including reduced lung volumes, displacement of intrathoracic organs, restricted rib movement, and altered respiratory muscle mechanics.[37]
  • Scoliosis also reduces the compliance of both the chest wall and lungs, increasing the effort required for breathing at rest, during physical activity, and while sleeping.[37]
  • In severe cases, complications such as pulmonary hypertension and respiratory failure can arise[37]

Studies have demonstrated a relationship between thoracic spinal deformity and pulmonary function with several factors playing a key role including:[37]

  •  Severity of the curve
  • Number of affected vertebrae
  • Location of the curve
  • Amount of reduction of thoracic kyphosis
  • A study into the effectiveness of a respiratory rehabilitation program in children with scoliosis that included:

Most PSSE programs use specific breathing techniques during exercise in order to facilitate de-rotation of the spine and correction of collapsed areas along the spinal curvature. It has been found that respiratory rehabilitation has a positive effect on increasing pulmonary function of children with scoliosis.[5]

Surgical Treatment

Surgical treatment for scoliosis is typically indicated for curves exceeding 45-50° by the Cobb method pending that:

  • Curves > 50° progress even after skeletal maturity[38]
  • Curves >60° can cause loss of pulmonary function, with larger curves leading to respiratory failure[38]
  • The greater the curve progression, the more surgically challenging correction becomes[38]
Hybrid constructs using pedicle screws, hooks, and wires. Right thoracic curve between the T5 and T11 was corrected from 70 to 23 degrees.
Surgical Techniques
  • The most common type of scoliosis surgery, as well as the gold standard, is a posterior spinal fusion.[18][39]
  • In the spinal fusion, more anchors are used to connect the rod and the spine, resulting in better correction and less frequent implant failures. Use of screws, hooks, metal rods, and wires are typically used to hold part of the spine straight and still while the old and new bone material fuses together.[39]
  • Epiphysiodesis on the convex side of the deformity with or without instrumentation is a technique that provides gradual progressive correction and arrest of the progression of curves.[39]
  • If the scoliosis is progressing rapidly at a young age, surgeons may insert a growing rod that can adjust in length as the child grows. This growing rod is attached to the top and bottom sections of the spinal curvature and is usually lengthened every 6 months.[39]
  • Minimally invasive and growth-friendly surgical techniques, including vertebral body tethering (VBT), are increasingly used in selected patients to preserve spinal motion whilst correcting deformity.[40]
  • In neuromuscular scoliosis (NMS), surgical strategies often require longer fusion constructs, frequently extending to the pelvis, due to associated pelvic obliquity, global spinal imbalance, and hypotonia.[18]
  • For congenital scoliosis, specifically patients aged 2-12 years, preservation of the intervertebral disc is considered clinically significant during hemivertebra resection. It has been shown that disc preservation may optimize postoperative sagittal alignment and reduce degeneration of the segment adjacent to the surgical site without compromising curve correction.[18]

Surgical risks include infection, implant failure, neurological injury, and adjacent segment degeneration; thorough preoperative evaluation and patient selection are essential.[41]

Management of Functional Scoliosis

The management of functional scoliosis include: Insoles (LLD)[3], [[1]], and PSSE programs.[42]

[[2]] was designed to focus on achieving complete body integration and improve strength, balance and flexibility.[42] It has been shown that Pilates exercise performed by people with scoliosis is effective with:

  • Improving spinal deformity and posture
  • Decreasing the ATR
  • Improving spinal range of motion
  • Lowering the Cobb angle
  • Improving quality of life
  • Reducing pain

Summary of Scoliosis

Overall, the assessment of a person’s scoliosis is integral in decision making for that patient’s treatment plan and prognosis. The multi-disciplinary approach to treatment and management has been demonstrated to be the most beneficial for the patient and improves patient compliance.[33]

  • Management interventions are typically multi-factorially with patients benefiting from multiple treatments to obtain optimal results.
  • Every patient's scoliosis is different, requiring an individualized program which includes the patient's own goals and choices.
  • There are three different types of scoliosis: idiopathic, congenital and neuromuscular with most research following Idiopathic scoliosis due to the high prevalence of 75-85% of all scoliosis. [4]

References

  1. ↑ 1.0 1.1 1.2 1.3 Li M, Nie Q, Liu J, Jiang Z. Prevalence of scoliosis in children and adolescents: a systematic review and meta-analysis. Front Pediatr. 2024 Jul 22;12:1399049. doi: 10.3389/fped.2024.1399049.
  2. ↑ 2.0 2.1 American Association of Neurological Surgeons (AANS). Scoliosis [Internet]. Rolling Meadows (IL): AANS; [cited 2025 May 8]. Available from: https://www.aans.org/patients/conditions-treatments/scoliosis/
  3. ↑ 3.0 3.1 3.2 Marsiolo M, Careri S, Bandinelli D, Toniolo RM, Aulisa AG. Vertebral rotation in functional scoliosis caused by limb-length inequality: correlation between rotation, limb length inequality, and obliquity of the sacral shelf. J Clin Med. 2023;12(17):5571. doi:10.3390/jcm12175571. PMID: 37685636; PMCID: PMC10488457.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Wang S, Li M, Ren J, Tao J, Fang M, Kong L. Global prevalence and associated risk factors of scoliosis in children and adolescents: a systematic review and meta-analysis. BMC Public Health. 2025 Oct 28;25:3640. doi: 10.1186/s12889-025-24905-4.
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O'Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3. doi: 10.1186/s13013-017-0145-8.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Standring S, editor. Gray's anatomy: the anatomical basis of clinical practice. 42nd ed. Philadelphia (PA): Elsevier; 2021.
  7. ↑ 7.0 7.1 7.2 7.3 Bazira PJ. Clinically applied anatomy of the vertebral column. Surgery (Oxf). 2024 Jun;42(6):355–363. doi: 10.1016/j.mpsur.2024.03.007.
  8. ↑ 8.0 8.1 Aubin CE, Lenke LG, Vitale M, Smith JS, Lafage V, Welborn MC, Larson AN, Kaito T, Newton PO, Mullin J, Caouette C, Ilharreborde B. The SRS–Lenke–Aubin 3D classification of adolescent idiopathic scoliosis. Spine Deform. 2025. doi: 10.1007/s43390-025-01253-2.
  9. ↑ 9.0 9.1 9.2 Grivas TB, Vasiliadis E, Soultanis K, Lykissas M, Katzouraki G, Sekouris N, et al. Idiopathic scoliosis progression: presenting rib and segmental rib index as predictors—a literature review. Med Sci (Basel). 2025 May 21;13(2):62. doi: 10.3390/medsci13020062.
  10. ↑ Li L, Wong MS. The application of machine learning methods for predicting the progression of adolescent idiopathic scoliosis: a systematic review. BioMed Eng OnLine. 2024;23:80. doi: 10.1186/s12938-024-01272-6.
  11. ↑ 11.0 11.1 Petrosyan E, Fares J, Ahuja CS, Lesniak MS, Koski TR, Dahdaleh NS, et al. Genetics and pathogenesis of scoliosis. Neurosurg Clin N Am. 2023;34(3):365-374. doi: 10.1016/j.nec.2023.02.003.
  12. ↑ 12.0 12.1 12.2 Coşkun E, Bucak ÖF. A comprehensive review of adult scoliosis: Advances in pathogenesis, diagnosis, and management strategies. Turk J Phys Med Rehabil. 2025;71(4): 417-426. doi: 10.5606/tftrd.2025.16476.
  13. ↑ 13.0 13.1 Sung S, Chae HW, Lee HS, Kim S, Kwon JW, Lee SB, et al. Incidence and surgery rate of idiopathic scoliosis: a nationwide database study. Int J Environ Res Public Health. 2021;18(15):8152. doi: 10.3390/ijerph18158152.
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 Scoliosis Research Society (SRS). Scoliosis [Internet]. Milwaukee (WI): SRS; [cited 2026 May 11]. Available from: https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis
  15. ↑ Grabala P. Congenital scoliosis: a comprehensive review of diagnosis, management, and surgical decision-making in pediatric spinal deformity—an expanded narrative review. J Clin Med. 2025;14(22):8085. doi: 10.3390/jcm14228085.
  16. ↑ 16.0 16.1 An JK, Berman D, Schulz J. Back pain in adolescent idiopathic scoliosis: a comprehensive review. J Child Orthop. 2023;17(2):126-140. doi: 10.1177/18632521221149058.
  17. ↑ 17.0 17.1 Lee H, Janjua F, Ragab A, Moran J, Haims A, Rubio D, et al. Total spine MRI for the preoperative evaluation of adolescent idiopathic scoliosis: part 1. Clin Imaging. 2022;82:96 -101. doi: 10.1016/j.clinimag.2021.11.005.
  18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 18.6 18.7 Leal LD, dos Santos JS, Domingos LT, Ferreira Júnior MS, Azevedo Nora FGS. Comprehensive systematic review and evidence synthesis on the morphological, epidemiological, diagnostic, biomechanical, psychosocial, and therapeutic dimensions of scoliosis. Int J Orthop Bone Disord. 2025;7(1):61-68. doi: 10.33545/26648946.2025.v7.i1a.47.
  19. ↑ 19.0 19.1 19.2 19.3 19.4 Popko J, Kwiatkowski M. Scoliosis: review of diagnosis and treatment. Pol J Appl Sci. 2018;4(1):23-28. doi: 10.19260/PJAS.2018.4.1.06.
  20. ↑ 20.0 20.1 Russo AP, Pastorello Y, Dénes L. Automated Cobb angle measurements for scoliosis diagnosis and assessment: AI applications and accuracy enhancement through image processing techniques. Cureus. 2024 Aug 12;16(8):e66736. doi: 10.7759/cureus.66736.
  21. ↑ 21.0 21.1 21.2 21.3 21.4 Bagó J, Climent JM, Pérez-Grueso FJS, Pellisé F. Outcome instruments to assess scoliosis surgery. Eur Spine J. 2012;22(Suppl 2):195-202. doi: 10.1007/s00586-012-2352-6.
  22. ↑ Parent EC, Vaclavik M, Bourgoin C, Hebert C, Bouwmeester M, Cheslock S, Collins R, Potgieter S, Coles M, Schreiber S, Donzelli S, Warner C. Inventory of patient-reported outcome measures used in the non-operative care of scoliosis: a scoping review. Children (Basel). 2023 Jan 29;10(2):239. doi: 10.3390/children10020239.
  23. ↑ Matamalas A, D'Agata E, Sanchez-Raya J, Bago J. Trunk appearance perception scale for physicians (TAPS-Phy) - a valid and reliable tool to rate trunk deformity in idiopathic scoliosis. Scoliosis Spinal Disord. 2016;11:24. doi: 10.1186/s13013-016-0085-8.
  24. ↑ d'Astorg H, Bourret S, Ramos-Pascual S, Szadkowski M, Le Huec JC. Comparison of Cobb angle measurements for scoliosis assessment using different imaging modalities: a systematic review. EFORT Open Rev. 2023 Jun 8;8(6):489–498. doi: 10.1530/EOR-23-0032.
  25. ↑ Larson JE, Meyer MA, Boody B, Sarwark JF. Evaluation of angle trunk rotation measurements to improve quality and safety in the management of adolescent idiopathic scoliosis. J Orthop. 2018 May 7;15(2):563–565. doi: 10.1016/j.jor.2018.05.032.
  26. ↑ Johari J, Sharifudin MA, Ab Rahman A, Omar AS, Abdullah AT, Nor S, et al. Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients. Singapore Med J. 2016 Jan;57(1):33-38. doi: 10.11622/smedj.2016008.
  27. ↑ Ren J, Wang S, Li M, Zhou X, Wen Y, Wen Z, et al. Comparative efficacy of conservative interventions for adolescent idiopathic scoliosis: a systematic review and network meta-analysis of randomised controlled trials. Syst Rev. 2025;14:156. doi: 10.1186/s13643-025-02893-1.
  28. ↑ 28.00 28.01 28.02 28.03 28.04 28.05 28.06 28.07 28.08 28.09 Kaelin AJ. Adolescent idiopathic scoliosis: indications for bracing and conservative treatments. Ann Transl Med. 2020 Jan;8(2):28. doi: 10.21037/atm.2019.09.69.
  29. ↑ Minsk MK, Venuti KD, Daumit GL, Sponseller PD. Effectiveness of the Rigo Chêneau versus Boston-style orthoses for adolescent idiopathic scoliosis: a retrospective study. Scoliosis Spinal Disord. 2017 Mar 20;12:7. doi: 10.1186/s13013-017-0117-z.
  30. ↑ Hahn D, Artajos A, Elliot X, Jevric T, Moore A, Swaby L, Hind D, Cole AA. A scoping review of published reviews on the use of bracing in scoliosis. Spine Deform. 2026 Mar 3. doi: 10.1007/s43390-026-01319-9.
  31. ↑ Wang Y, Feng Z, Wu Z, Qiu Y, Zhu Z, Xu L. Brace treatment can serve as a time-buying tactic for patients with congenital scoliosis. J Orthop Surg Res. 2019 Jun 27;14:194. doi: 10.1186/s13018-019-1244-4.
  32. ↑ Ma RT, Wu Q, Xu ZD, Zhang L, Wei YX, Gao Q. Exercise therapy for adolescent idiopathic scoliosis rehabilitation: a bibliometric analysis (1999–2023). Front Pediatr. 2024;11:1342327. doi: 10.3389/fped.2023.1342327.
  33. ↑ 33.0 33.1 33.2 33.3 33.4 33.5 Berdishevsky H, Lebel VA, Bettany-Saltikov J, Rigo M, Lebel A, Hennes A, Romano M, Białek M, M'hango A, Betts T, de Mauroy JC, Durmala J. Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools. Scoliosis Spinal Disord. 2016;11:20. doi: 10.1186/s13013-016-0076-9.
  34. ↑ Scoli-Fit. Scoli-Fit exercises for scoliosis [Internet]. YouTube; 2019 [cited 2025 May 14]. Available from: https://www.youtube.com/watch?v=JUXcQvzx2H0&t=5s
  35. ↑ Romano M. What is SEAS: a short introduction given by Michele Romano, director of physiotherapy at ISICO [Internet]. YouTube; 2013 [cited 2025 May 14]. Available from: https://www.youtube.com/watch?v=x6iBd2MoU4k
  36. ↑ Romano M. ISICO and the SEAS approach [Internet]. YouTube; 2013 [cited 2025 May 14]. Available from: https://www.youtube.com/watch?v=pxiiiaO-tr4
  37. ↑ 37.0 37.1 37.2 37.3 37.4 Hashem M. Assessment of pulmonary function after treatment of scoliosis: meta-analysis and review article. Medicina (Kaunas). 2025 Jun 23;61(7):1127. doi: 10.3390/medicina61071127.
  38. ↑ 38.0 38.1 38.2 Lenz M, Oikonomidis S, Harland A, Fürnstahl P, Farshad M, Bredow J, Eysel P, Scheyerer MJ. Scoliosis and prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression. Eur Spine J. 2021;30:1813–1822. doi: 10.1007/s00586-021-06817-0.
  39. ↑ 39.0 39.1 39.2 39.3 Maruyama T, Takeshita K. Surgery for idiopathic scoliosis: currently applied techniques. Clin Med Pediatr. 2009 Mar 4;3:39–44. doi: 10.4137/cmped.s2117.
  40. ↑ Hammad AM, Balsano M, Ahmad AA. Vertebral body tethering: an alternative to posterior spinal fusion in idiopathic scoliosis? Front Pediatr. 2023 Mar 14;11:1133049. doi: 10.3389/fped.2023.1133049.
  41. ↑ Gatam L, Phedy P, Mahadhipta H, Husin S, Gatam AR, Kadar PD, et al. Surgical outcomes and complication rates in severe scoliosis: a systematic review. SICOT-J. 2025 Sep 19;11:53. doi: 10.1051/sicotj/2025050.
  42. ↑ 42.0 42.1 Li F, Omar Dev R, Soh KG, Wang C, Yuan Y. Effects of Pilates exercises on spine deformities and posture: a systematic review. BMC Sports Sci Med Rehabil. 2024;16:55. doi:10.1186/s13102-024-00887-1.
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