Snapshot A 12-year-old girl presents to her pediatrician’s office for an annual visit. She reports that she feels like her body is not symmetric, but has attributed this to a growth spurt and growing pains. On physical exam, there is subtle curvature of her spine. When she bends forward, there is some bony prominences from her ribs and curvature of the spine. Inclinometer shows > 7° of curvature. She is sent for radiography, which confirms the diagnosis. Introduction Clinical definition lateral curvature of the spine most common type is adolescent idiopathic scoliosis Epidemiology incidence 2% of the population demographics female > male onset in adolescence but can be earlier (infantile or juvenile) most common spinal deformity risk factors female family history Pathogenesis exact pathogenesis is unknown but the curvature worsens as the spine grows Associated conditions connective tissue disorders (e.g., Marfan syndrome) neurofibromatosis Down syndrome Prognosis scoliosis is not progressive after skeletal maturity Presentation Symptoms asymmetry in the back, shoulders, waists, or breasts typically not very painful but may have nonspecific aching if there is severe pain, may indicate an underlying condition such as spinal tumor or infection may have rib prominence Physical exam asymmetry in shoulder or waist curvature of the spine when standing or sitting provocative tests Adam forward bend test with inclinometer patient’s back is assessed for scoliosis as they bend forward if inclinometer is > 6°, the test is suggestive for scoliosis normal neurologic exam Imaging Radiographs indications for all patients suspected of having scoliosis confirms diagnosis recommend view coronal posteroanterior spinal radiographs finding Cobb angle (lateral curvature of spine) ≥ 10° Studies Making the diagnosis based on clinical presentation and imaging studies Differential Spinal curvature due to unequal leg length distinguishing factor curvature resolves when the patient is seated Tethered cord syndrome distinguishing factor abnormal neurologic exam, including weakness or spasticity and abnormal reflexes Treatment Management approach treatment depends on the Cobb angle Conservative monitoring with frequent radiography indication Cobb angle < 25° Non-operative bracing indication Cobb angle 25-45° Operative surgical fusion of the spine indication Cobb angle > 45° prevent curve progression Complications Restrictive lung disease Chronic back pain