Scoli-Idiopathic Adolescent (>10)
Approach to Adolescent Idiopathic Scoliosis

Curve Progression – 4 Growth Factors, 2 Curve Factors
1. the younger the patient at diagnosis, the higher the risk of progression
2. the presentation prior to menarch portends a higher risk of progression
3. the lower the Risser grade at curve detection the higher the risk of progression
4. females with comparable curves to males have 10 times the risk of progression
5. double curves have a greater tendency to progress than single
6. the larger the curve at detection, the higher the risk of progression

Risser Grade versus Curve Magnitude: (The classic Lonstein natural history paper)
– if you are Risser 0-1, a curve 50, lumbar curves >30 (we tend to worry more about lumbar curves >50)
– decompensation, rotation, apical deviation
– single or multiple curves
– proximity to skeletal maturity and progression despite bracing

King Classification
I – S shaped curve, lumbar curve is larger and stiffer than thoracic curve; both cross midline
II – S shaped curve, thoracic curve is larger and stiffer than lumbar curve; both cross midline
III – single thoracic curve, no compensatory lumbar curve; may be a small lumbar curve that does not cross midline
IV – long thoracolumbar curve in which L4 tilts into the curve
V – double thoracic curve – the upper curve is structural as seen on side bending

Surgical Rules
– instrumentation should include end vertebraes
– fusion should end at the stable vertebra – lying within the center sacral line
– watch out for junctional kyphosis between a thoracic and lumbar curve – if present, must include the lumbar curve