Links to References on Adolescent Idiopathic Scoliosis:

Revised: July 1, 7, 30, Aug 25, Sept 1, 2, Dec 30, 2025, Feb 2, 10, March 7, April 2 2026

There are two distinct professional (International) societies of health professionals dedicated to Scoliosis patient care and patients with spinal deformities. The Scoliosis Research Society (SRS) is a well-established, highly respected, international society that was founded in 1966 and is committed to treatment, research and education in the field of spinal deformities. Current membership includes over 1,000 of the world's leading spine surgeons, researchers, physician assistants and orthotists who are involved in research and treatment of spinal deformities. Their website provides extensive educational resources and they sponsor their own Journal Spine Deformity. The second is SOSORT, the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment which "is dedicated to the advancement of evidence-based non-operative care for people with scoliosis and structural changes of the spine". SSORT is a non-profit International society of Doctors, Physical Therapists. Orthotists and Psychologists formed in 2003, see About-us and Board members and SOSORT Education Publications.

The following is a curated list of links to references on Adolescent Idiopathic Scoliosis from trusted sites.

1. Diagnosing-Scoliosis Diagnosis & Screening of Scoliosis FAQ with patient videos. See Scoliosis Handbook for Patients
2. Idiopathic Scoliosis in Children and Adolescents (Overview) from the American Academy of Orthopaedic Surgeons AAOS last reviewed 2021
3. From the Scoliosis Research Society (SRS) Glossary of terms and for
4. Parents/patients from the National Scoliosis Foundation Glossary of terms
5. Choudhry MN, Ahmad Z, Verma R. Adolescent Idiopathic Scoliosis. Open Orthop J. 2016 May 30;10:143-54. doi: 10.2174/1874325001610010143. PMID: 27347243; PMCID: PMC4897334\ "...Scoliosis refers to deviation of spine greater than 10 degrees in the coronal plane. Idiopathic Scoliosis is the most common spinal deformity that develops in otherwise healthy children. The sub types of scoliosis are based on the age of the child at presentation. Adolescent idiopathic scoliosis (AIS) by definition occurs in children over the age of 10 years until skeletal maturity...AIS results in higher incidence of back pain and discontent with body image. Curves greater than 50 degrees in thoracic region and greater than 30 degrees in lumbar region progress at a rate of 0.5 to 1 degree per year into adulthood. Curves greater than 60 degrees can lead to pulmonary functional deficit. Therefore once the disease is recognized, effective treatment should be instituted to address the deformity and prevention of its long-term sequelae... The objective of this review is to outline the features of AIS to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome... It can be classified into congenital, neuromuscular, and idiopathic... the behaviour and management of these conditions are potentially different... we will cover the most common of the three classifications - adolescent idiopathic scoliosis..."
6. 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. PMID: 29435499; PMCID: PMC5795289."... Adolescent idiopathic scoliosis (AIS) with a Cobb angle above 10° occurs in the general population in a wide range of prevalence from 0.93 to 12% ... 2 to 3% is the value the most often found in the literature, and it has been suggested that the incidence changes according to latitude... Approximately 10% of these diagnosed cases require conservative treatment and approximately 0.1–0.3% require operative correction of the deformity. Progression of AIS is much more frequently seen in females. When the Cobb angle is 10 to 20°, the ratio of affected girls to boys is similar (1.3:1), increasing to 5.4:1 for Cobb angles between 20° and 30°, and 7:1 for angle values above 30°... If the scoliosis angle at completion of growth exceeds a “critical threshold” (most authors assume it to be between 30° and 50° [33], there is a higher risk of health problems in adult life, decreased quality of life, cosmetic deformity and visible disability, pain and progressive functional limitations...."
7. Kuang H, Chen L, Huang M, Chen J. Management of adolescent scoliosis: a comprehensive review of etiology and rehabilitation. Front Pediatr. 2025 Jul 16;13:1596400. doi: 10.3389/fped.2025.1596400. PMID: 40740816; PMCID: PMC12307321."...This review synthesizes recent advances in understanding the pathogenesis of AS and explores the latest developments in non-surgical rehabilitation strategies, including physical therapy, bracing, exercise therapy, and psychological interventions. Emerging technologies, such as artificial intelligence, wearable devices, and virtual reality, are revolutionizing diagnostic accuracy and treatment personalization. The review also highlights the critical role of multidisciplinary collaboration and psychological support in improving patient outcomes. By identifying key research gaps and proposing innovative future directions—such as the integration of epigenetics, advanced biomechanical modeling, and AI-driven precision rehabilitation—this article aims to provide clinicians and researchers with a comprehensive framework for managing AS. Ultimately, this review underscores the importance of early detection, personalized treatment, and long-term follow-up in enhancing the quality of life for adolescents with scoliosis..."
8. Columbia University Irvine Medical Center Comprehensive patient resources: What is Scoliosis, different types, treatments, diagnostics and more.
9. El-Hawary R, Chukwunyerenwa C. Update on evaluation and treatment of scoliosis. Pediatr Clin North Am. 2014 Dec;61(6):1223-41. doi: 10.1016/j.pcl.2014.08.007. Epub 2014 Sep 12. PMID: 25439021."...The goal of treatment is to prevent curve progression. If a curve progresses beyond 50°, it will likely continue to progress into adulthood...The usual presenting complaint is chest wall or back asymmetry. Adolescent girls will sometimes complain of breast asymmetry, unequal shoulders, uneven waistline and difficulty with fitting clothes..."
10. Weinstein, Stuart L. MD. The Natural History of Adolescent Idiopathic Scoliosis. Journal of Pediatric Orthopaedics 39():p S44-S46, July 2019. | DOI: 10.1097/BPO.0000000000001350 “...Introduction: Adolescent idiopathic Scoliosis (AIS) affects 2% to 3% of the population of which only 0.3% to 0.5% of affected patients will have a curvature of >20 degrees, the curve magnitude at which treatment is generally recommended. For AIS the current natural history data is limited and most of the information comes from a small body of literature from the University of Iowa...this unique cohort of untreated patients was again studied in the 1990s, at an average of 51 years after diagnosis, when the average age of the patients was 66 years...Results: Patients with untreated AIS can function well as adults, become employed, get married, have children, and grow to become active older adults. Unfortunately, untreated scoliosis may lead to increased back pain and pulmonary symptoms for patients with large thoracic curves. Patients with untreated AIS can also develop substantial deformity, and the cosmetic aspect of this condition cannot be disregarded...”
11. Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, Stokes IA, Weinstein SL, Burwell RG. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015 Sep 24;1:15030. doi: 10.1038/nrdp.2015.30. PMID: 27188385.
12. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013 Feb;7(1):3-9. doi: 10.1007/s11832-012-0457-4. Epub 2012 Dec 11. PMID: 24432052; PMCID: PMC3566258."... Conclusion Idiopathic adolescent scoliosis is a common disease with a prevalence of 0.47–5.2 %. Prevalence and curve severity are higher for girls than for boys, and the female to male ratio increases with increasing age of the children..."
13. Trobisch P, Suess O, Schwab F. Idiopathic scoliosis. Dtsch Arztebl Int. 2010 Dec;107(49):875-83; quiz 884. doi: 10.3238/arztebl.2010.0875. Epub 2010 Dec 10. PMID: 21191550; PMCID: PMC3011182.
14. 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 Dec 16. doi: 10.1007/s43390-025-01253-2. Epub ahead of print. PMID: 41400792. "Abstract:...the proposed SRS-Lenke-Aubin 3D classification... enriches the existing Lenke framework by incorporating practical transverse plane descriptors compatible with standard imaging workflows. This system offers a clinically meaningful step toward more complete 3D characterization of AIS, with potential applications in improving surgical planning, assessing outcomes, and supporting future integration with automated 3D tools...."
15. Wei W, Cheng L, Dong Y, Zhang T, Deng Y, Gong J, Xie F, Yang J. 2D and 3D Classification Systems for Adolescent Idiopathic Scoliosis: Clinical Implications and Technological Advances. Orthop Surg. 2025 Apr;17(4):999-1020. doi: 10.1111/os.14362. Epub 2025 Jan 18. PMID: 39825698; PMCID: PMC11962298.
16. Ovadia D. Classification of adolescent idiopathic scoliosis (AIS). J Child Orthop. 2013 Feb;7(1):25-8. doi: 10.1007/s11832-012-0459-2. Epub 2012 Dec 25. PMID: 24432055; PMCID: PMC3566250
17. Grivas TB, Vasiliadis E, Mouzakis V, Mihas C, Koufopoulos G. Association between adolescent idiopathic scoliosis prevalence and age at menarche in different geographic latitudes. Scoliosis. 2006 May 23;1:9. doi: 10.1186/1748-7161-1-9. PMID: 16759371; PMCID: PMC1501058. "...Conclusion In this survey it appears that late age at menarche is parallel with higher prevalence of AIS, especially in latitudes northern than 30 degrees. Pubarche appears later in girls that live in northern latitudes and thus prolongs the period of spine vulnerability while other pre-existing or aetiological factors are contributing to the development of AIS."

Other less common types of Scoliosis in younger children, under 10 years:
 Early-Onset Scoliosis (EOS)

Note: Primary Care Providers should be aware of Early-Onset Scoliosis (EOS) in young children. While Adolescent Idiopathic Scoliosis (AIS) makes up for up to 80% of cases of scoliosis in children, ages 10-17 yrs old, EOS which refers to curvature of the spine that presents in children under 10 years, makes up for the remaining 20% of cases. EOS is uncommon compared to AIS and it not the same. (Note: recently the term EOS was established/broadened as the new classification for scoliosis, curvature of the spine, presenting in children under 10 years, one of the former names was Juvenile idiopathic scoliosis). It is critically important for primary care providers and parents to be aware that Children with EOS can present with very agressive and severe curves. that can compromise the lungs and heart. Prompt and timely referral to a paediatric orthopaedic spine/Scoliosis clinic or surgeon is critically important. Bracing can help in some cases.

INFORMATION RESOURCES ON EOS:

Orthokids Pediatric Orthopedic Society of North American Early Onset Scoliosis (for parents)

From the Scoliosis Research Society (SRS) Early-Onset Scoliosis   includes informative FAQ and educational videos.

" Early Onset Scoliosis refers to spine curvature that is present before 10 years of age. Different causes:
• Idiopathic - Curves for which there is no apparent cause.
• Congenital - Vertebrae develop incorrectly inutero. It is sometimes associated with cardiac and renal abnormalities. Evaluation may include studies of heart and kidneys.
• Neuromuscular - In children with neuromuscular disorders including spinal muscular atrophy, cerebral palsy, spina bifida and brain or spinal cord injury.
• Syndromic - Certain syndromes, such as Marfans, Ehlers-Danlos and other connective tissue disorders, as well as neurofibromatosis, Prader-Willi, and many bone dysplasias may be associated with EOS...."

The following is a curated list.

1. Helenius IJ. Treatment strategies for early-onset scoliosis. EFORT Open Rev. 2018 May 21;3(5):287-293. doi: 10.1302/2058-5241.3.170051. PMID: 29951268; PMCID: PMC5994631.'Introduction Early-onset scoliosis (EOS) is defined as a spinal deformity occurring before ten years of age. Untreated EOS or early spinal fusion resulting in a short spine is associated with increased mortality and cardiopulmonary compromise. Since EOS is a heterogeneous condition, a uniformly accepted classification has been proposed.1 This includes age, aetiology (congenital, neuromuscular, syndromic and idiopathic), major curve, kyphosis and progression modifier. Surgery is indicated for progressive deformities EOS may progress rapidly and, therefore, prompt clinical diagnosis and referral to a paediatric orthopaedic unit is necessary...'
2. Grabala P, Gupta MC, Pereira DE, Latalski M, Danielewicz A, Glowka P, Grabala M. Radiological Outcomes of Magnetically Controlled Growing Rods for the Treatment of Children with Various Etiologies of Early-Onset Scoliosis-A Multicenter Study. J Clin Med. 2024 Mar 7;13(6):1529. doi: 10.3390/jcm13061529. PMID: 38541757; PMCID: PMC10970737.
3. Charles YP, Daures JP, de Rosa V, Diméglio A. Progression risk of idiopathic juvenile scoliosis during pubertal growth. Spine (Phila Pa 1976). 2006 Aug 1;31(17):1933-42. doi: 10.1097/01.brs.0000229230.68870.97. PMID: 16924210.
4. Lenke, Lawrence G. MD; Dobbs, Matthew B. MD. Management of Juvenile Idiopathic Scoliosis. The Journal of Bone & Joint Surgery 89(suppl_1):p 55-63, February 2007. | DOI: 10.2106/JBJS.F.00644
   
   

Types of Non-idiopathic EOS (Congenital, Neuromuscular, Syndromic: Marfan Syndrome, Loeys-Dietz Syndrome, Ehlers Danlos Syndrome) in Children:

( HEALTH ALERT revised Mar 7, 13, 2026 :
PARENTS AND HEALTHCARE PROVIDERS NEED TO BE AWARE that spinal deformities, Scoliosis (from mild to severe), Kyphosis, early & severe Spondylolesthesis, very rare Kyphoscoliosis, often along with pees planus (flat feet) in children can be clinical presenting signs of an underlying rare genetic (aka syndromic) connective tissue disorder also referred to as a Heritable Connective Tissue Disorder (HCTD), IF accompanied by other features and symptoms. These HCTDs can weaken (supportive) connective tissue found in many places of the body including skin, ligaments, cartilage, bones, eyes, teeth, joints, even walls of organs and blood vessels. Symptoms can range from mild to severe. HCTDs includes MARFAN SYNDROME (MFS) characterized by distinguishing features, which may include: disproportionately long arms, legs, fingers, tall, slender body build, flat feet, hypermobile or loose joints, sunken or portruding chest, long narrow head, narrow jaw, crowded teeth, ectopia lentis, near-sightedness (myopia), stretch marks not related to weight gain or loss, as well as LOEYS-DIETZ SYNDROME (LDS) (more agressive cardiovascular disease then MFS) where distinguishing features may include widely spaced eyes, bifid uvula, cleft palate, clubfoot, high-grade spondylolisthesis, poor wound healing, soft velvety skin that bruises easily, eczema, cervical instability (and more) , and shared features with MFS of flat feet, hypermobile loose joints, and chest deformity and some very rare subtypes (Kyphoscoliotic EDS (kEDS) & vascular EDS (vEDS)) of EHLERS-DANLOS SYNDROMES (EDS), that share the features of hypermobile or loose joints (joint hypermobility), loose stretchy skin (skin hyperextensibility), and tissue fragility (can present as easy bruising and poor wound healing) and have their own unique additional features and identifying gene markers.

   WHY THIS MATTERS:
Public health in Canada does not screen children for rare diseases (nor common Adolescent Idiopathic Scoliosis (AIS)). Awareness is low among primary care providers and the public. It is critically important to recognize that children (& young adults) with these genetic/heritable connective tissue disorders — are at high risk of serious cardiovascular complications including aortic enlargement, which can lead to life-threatening aortic dissection (rupture) causing premature death. EARLY DIAGNOSIS by referral to a cardiologist/aortic specialist clinic for a cardiac examination that includes an echocardiogram and referral to a medical geneticist (for molecular genetic testing) is critically important and can be life-saving. FOR INFORMATION/REFERENCES and WHERE TO FIND HELP
VISIT ==> Links to resources and references on HCTDs.

Please watch Family of woman who died after undiagnosed Marfan syndrome speaks out CTV News, Toronto News, Jan 7, 2026 and the Ontario family's Federal Petition advocating screening for rare diseases. )

1. Loughenbury PR, Tsirikos AI. Current concepts in the treatment of neuromuscular scoliosis: clinical assessment, treatment options, and surgical outcomes. Bone Jt Open. 2022 Jan;3(1):85-92. doi: 10.1302/2633-1462.31.BJO-2021-0178.R1. PMID: 35084206; PMCID: PMC9047085.
2. Mackel CE, Jada A, Samdani AF, Stephen JH, Bennett JT, Baaj AA, Hwang SW. A comprehensive review of the diagnosis and management of congenital scoliosis. Childs Nerv Syst. 2018 Nov;34(11):2155-2171. doi: 10.1007/s00381-018-3915-6. Epub 2018 Aug 4. PMID: 30078055.
3. Samuel Yoon, Karim Aboelmagd, Archana Sivakuganandan, Amna Zulfiqar, Anne Murphy, Stanley Moll, Julia Sorbara, Brett Rocos, David Lebel, Mark Camp. Preoperative zoledronate is safe for children with medical complexity undergoing posterior spinal fusion for neuromuscular scoliosis. Canadian Journal of Surgery, Vol. 68 (6 Suppl 3) December 12, 2025 DOI: 10.1503/cjs.020125, Abstract ID 150 Program Code CPSS09, Division of Orthopaedic Surgery,University of Toronto, Toronto, Ont.; Division of Orthopaedic Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ont.; University of Toronto School of Medicine, Toronto, Ont.; Division of Orthopaedic Surgery, Hospital for Sick Children,Toronto, Ont.; Division of Endocrinology, Hospital for Sick Children, Toronto, Ont.; Department of Pediatrics, University of Toronto, Toronto, Ont.; Division of Spine Surgery, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina; Division of Orthopaedic Surgery, University of Toronto,Toronto, Ont., "Background: Children with medical complexity (CMC) and neuromuscular scoliosis (NMS) are prone to bone fragility and secondary osteoporosis. Osteoporotic bone compounds operative challenges, contributing to complications such as implant failure, pedicle screw loosening, proximal junctional kyphosis, and pseudarthrosis. Preoperative optimization of bone fragility has the potential to improve surgical outcomes in CMC. Despite evidence for the safety and efficacy of zoledronate infusions in pediatric conditions (e.g., osteogenesis imperfecta), its tolerance, safety, and efficacy in CMC with NMS is not established. The current investigation aims to establish the safety of preoperative bisphosphonate therapy in CMC and NMS. Methods: A retrospective review was conducted of patients who had undergone zoledronate infusions during their preoperative optimization. The protocol included 3 infusions with an initial 0.0125 mg/kg dose, a 6-week 0.0375 mg/kg dose, and 6-month 0.05 mg/kg dose. Surgery was scheduled no sooner than 6 weeks after infusion.... Conclusion: No major adverse events were noted after preoperative zoledronate infusions. The minor adverse events were self-resolving or resolved with minimal intervention. Zoledronate infusion can therefore safely be included as part of a preoperative optimization pathway in CMC with NMS."
4. Vialle R, Thévenin-Lemoine C, Mary P. Neuromuscular scoliosis. Orthop Traumatol Surg Res. 2013 Feb;99(1 Suppl):S124-39. doi: 10.1016/j.otsr.2012.11.002. Epub 2013 Jan 19. PMID: 23337438.
5. Garg S. Management of scoliosis in patients with Duchenne muscular dystrophy and spinal muscular atrophy: A literature review. J Pediatr Rehabil Med. 2016;9(1):23-9. doi: 10.3233/PRM-160358. PMID: 26966797.
6. McCarthy JJ, D'Andrea LP, Betz RR, Clements DH. Scoliosis in the child with cerebral palsy. J Am Acad Orthop Surg. 2006 Jun;14(6):367-75. doi: 10.5435/00124635-200606000-00006. PMID: 16757676.
7. Sponseller PD, Bhimani M, Solacoff D, Dormans JP. Results of brace treatment of scoliosis in Marfan syndrome. Spine (Phila Pa 1976). 2000 Sep 15;25(18):2350-4. doi: 10.1097/00007632-200009150-00013. PMID: 10984787.
8. Andersen NH, Hauge EM, Baad-Hansen T, Groth KA, Berglund A, Gravholt CH, Stochholm K. Musculoskeletal diseases in Marfan syndrome: a nationwide registry study. Orphanet J Rare Dis. 2022 Mar 5;17(1):118. doi: 10.1186/s13023-022 02272-2. PMID: 35248143; PMCID: PMC8898450.
9. Taniguchi Y, Takeda N, Inuzuka R, Matsubayashi Y, Kato S, Doi T, Yagi H, Yamauchi H, Ando M, Oshima Y, Tanaka S. Impact of pathogenic FBN1 variant types on the development of severe scoliosis in patients with Marfan syndrome. J Med Genet. 2023 Jan;60(1):74-80. doi: 10.1136/jmedgenet-2021-108186. Epub 2021 Dec 16. PMID: 34916231; PMCID: PMC9811093.
10. Shere C, Clark EM. Systematic review of the association between isolated musculoskeletal hypermobility and adolescent idiopathic scoliosis. Arch Orthop Trauma Surg. 2023 Jun;143(6):3055-3076. doi: 10.1007/s00402-022-04508-z. Epub 2022 Jul 16. PMID: 35841409; PMCID: PMC10192177.
11. Giunta C, Rohrbach M, Fauth C, Baumann M. FKBP14 Kyphoscoliotic Ehlers-Danlos Syndrome. 2019 May 23. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2024. PMID: 31132235.
12. LoPresti MA, Athukuri P, Khan AB, Prablek M, Patel R, Mayer R, Bauer DF, Gerow FT, Morris SA, Lam S, Ravindra V. Thoracolumbar Scoliosis in Pediatric Patients With Loeys-Dietz Syndrome: A Case Series. Cureus. 2023 Mar 19;15(3):e36372. doi: 10.7759/cureus.36372. PMID: 37090272; PMCID: PMC10113178.
13. Stern CM, Pepin MJ, Stoler JM, Kramer DE, Spencer SA, Stein CJ. Musculoskeletal Conditions in a Pediatric Population with Ehlers-Danlos Syndrome. J Pediatr. 2017 Feb;181:261-266. doi: 10.1016/j.jpeds.2016.10.078. Epub 2016 Nov 28. PMID: 27908650.

Links to Publications (including research) on Curve Progression in AIS

The following is a curated list. Spine Deformity experts (surgeons) and many researchers primary focus is on preventing and treating severe curve progression in adolescents. However, Health professionals need to acknowledge that AIS is a complex genetic disease (polygenetic multifactorial disease), that is not just confined to adolescence. That curves over 25° COBB angle, continue to progress long-term, albeit slowly. .70-1% a year, after skeletal maturity is reached. And later in life can cause back pain and other signifcant health quality of life problems.

1. Geagea E, Rambo A, Krombholz K, Siddiqui A, Neal KM. Factors Related to Curve Progression in Adolescent Idiopathic Scoliosis Girls at Skeletal Maturity. Healthcare. 2025; 13(22):2857. https://doi.org/10.3390/healthcare13222857 "...Conclusion: This study offers one of the few focused analyses on the natural history of moderate (25–45°) AIS curves in skeletally mature girls with at least 24 months of follow-up. Curves measuring 25–45° can still progress, particularly those ≥35°, which showed a high risk of surpassing 40° and reaching the standard surgical threshold of ≥50° within 24 months. At our institution, curves > 40° are considered for surgery in conjunction with shared decision-making involving patients and their families. Risser 4 should not be assumed to have full maturity and can still progress; additional factors, such as Sanders staging and a shorter interval since menarche, can help guide decisions about continued monitoring or intervention. Progression was significantly associated with Risser stage 4 and a shorter interval between menarche and SM. Although some curves ≤ 35° progressed > 5°, none reached 50°, identifying this subgroup as lower risk. This information can help provide accurate curve counseling for patients with AIS and their families..."
2. Nam Y, Patel U, Chang DG, Lee YB, Lim J, Yang JH, Suh SW. Curve Progression in Adolescent Idiopathic Scoliosis with Cobb Angles Between 40 and 50 Degrees at the Late Stage of Skeletal Growth: A Minimum 5-Year Follow-Up Study. J Clin Med. 2025 Jul 25;14(15):5272. doi: 10.3390/jcm14155272. PMID: 40806894; PMCID: PMC12347580."...Conclusions In this study, significant curve progression was observed in 39.2% of the AIS patients even at the late stage of skeletal growth. A younger age and Risser stage IV were significantly associated with this progression. In addition, a larger baseline curve magnitude and Risser stage IV were associated with a final Cobb angle ≥ 50 degrees. Understanding these risk factors may aid clinicians in developing more appropriate management strategies for AIS patients at the late stage of skeletal growth. Given that curve progression may continue even after skeletal maturity, especially in patients with residual growth or a larger baseline curve magnitude, extended follow-up and timely clinical decision-making may help prevent progression beyond the surgical threshold."
3. Grivas TB, Vasiliadis E, Soultanis K, Lykissas M, Katzouraki G, Sekouris N, Lykouris D, Mazioti C, Mamzeri A, Papagianni D, Potamiti E, Kastrinis A, Theodosopoulos E. 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. PMID: 40407557; PMCID: PMC12101284. "...The present paper summarizes the current knowledge of factors that are involved in curve progression in idiopathic scoliosis and cites the numerous models that have been developed for prediction of IS progression. It also highlights the importance of the thorax in scoliotic deformity and introduces, for the first time, two factors that describe the deformity of the rib cage, namely, the Rib Index and the Segmental Rib Index, as predictors of IS progression..."
4. Khodaei, M., Parent, E., Le, L. et al. Identifying and validating prognostic parameters to predict curve progression in adolescents with idiopathic scoliosis. Eur Spine J (2025). https://doi.org/10.1007/s00586-025-08922-w "...Conclusions The results indicated that participants with lower RC (weaker bone, RC ≤ 0.06), larger US Cobb change (≥ 5°), and multiple curvatures (NOC > 1) were at a higher risk of curve progression..."
5. Ogata Y, Kotani T, Asada T, Ohyama S, Okuwaki S, Iijima Y, Sakuma T, Ohtori S, Yamazaki M.Timeline of curve progression around menarche in small adolescent idiopathic scoliosis curves without influence of braces: a single-center longitudinal cohort study of 1,090 patients Spine J. 2025 Jan 31:S1529-9430(25)00062-2. doi: 10.1016/j.spinee.2025.01.022. Epub ahead of print. PMID: 39894277. "...RESULTS Overall, 1,090 female patients were included, with a mean initial visit age of 12.9 years (standard deviation [SD]: 1.5) and a mean coronal Cobb angle of 17.5° (SD: 4.3). Curve progression was significantly decreased between 0–1 and 1–2 years post-menarche (0–1 year post-menarche: 2.9°/year vs. 1–2 years post-menarche: 1.3°/year; p=.03). After 2 years from menarche, the mean curve progression was less than 0.4°/year. The cut-off value of the curve magnitude for the final initiation of brace treatment at the timing of menarche was 20.5° (area under the curve: 0.89, p<.001, 95% confidence interval: 0.86–0.91). CONCLUSIONS This study highlights that in small AIS curves under 25°, minimal curve progression was observed after 2 years post-menarche, aiding follow-up strategies for AIS conservative treatment."
6. Negrini, S., Yaskina, M., Donzelli, S. et al. Puberty changes the natural history of idiopathic scoliosis: three prediction models for future radiographic curve severity from 1563 consecutive patients. Eur Spine J 33, 3767–3775 (2024). https://doi.org/10.1007/s00586-024-08487-0 "...We developed a retrospective model with the largest available sample in the literature and we aimed to investigate if using three peri-pubertal growth periods provides better prediction than a unique model... Three groups: BEFORE (age 6–10), AT (age 11-Risser 2) and AFTER (from Risser 3) the pubertal growth spurt. Available predictors: Cobb angle, curve type, sex, observation time, and Risser score...Curves increased over time mostly in AT, importantly in BEFORE, but also in AFTER...IS curve severities increase differently during growth with puberty stages. Model accuracy increases when tailored by growth spurt periods. Our models may help patients and clinicians share decisions, identify the risk of progression and inform treatment planning."
7. Parent EC, Donzelli S, Yaskina M, Negrini A, Rebagliati G, Cordani C, Zaina F, Negrini S. Prediction of future curve angle using prior radiographs in previously untreated idiopathic scoliosis: natural history from age 6 to after the end of growth (SOSORT 2022 award winner). Eur Spine J. 2023 Jun;32(6):2171-2184. doi: 10.1007/s00586-023-07681-w. Epub 2023 Apr 14. PMID: 37059884. "...Treatment selection for idiopathic scoliosis is informed by the risk of curve progression. Previous models predicting curve progression lacked validation, did not include the full growth/severity spectrum or included treated patients....Prediction models were proposed, which can help clinicians predict future curve severity expected in patients not receiving treatment. Our models offer the flexibility to predict at a future timepoints over the full growth period. One model allows such predictions using only simple clinical and radiographic data from an initial specialist consultation, and the other model allows taking advantage of clinical data from prior visits while untreated to improve prediction accuracy. The prediction accuracy of these validated models was very good with 80% or more predicted within 10°. Important predictors varied between models and included: curve severity, documented progression, curve types, skeletal maturity, age at consultation, time to the target prediction, and interactions between time and maturity and time and sex. The nonlinear effects of time in both models account for the rapid increase in curve angle at the beginning of growth and the slowed progression after maturity. Improved prediction ability may help clinicians inform treatment prescription or show families why no treatment is recommended."
8. Luhmann S, Zaaroor-Regev D, Upasani VV, Shufflebarger H. The natural history of curve behavior after brace removal in adolescent idiopathic scoliosis: a literature review. Spine Deform. 2023 May;11(3):567-578. doi: 10.1007/s43390-022-00638-x. Epub 2023 Jan 30. PMID: 36715866; PMCID: PMC10147768."...We identified a different progression profile where double-major curves progressed the most, followed by thoracic, thoracolumbar, and lumbar. ...curves continue to progress after brace treatment is completed... The magnitude and rate of curve progression is mainly dependent on the degree of curve at weaning as curves weaned at < 25° progress substantially less than curves weaned at ≥ 25° ..."
9. Curve Progression in Untreated Patients with Scoliosis (AIS) from the Scoliosis Research Society Education Resource Center. See table 1. "...Studies have consistently shown the more skeletally immature a patient is, the greater the chance of progression. It also shown the larger the curve at presentation, the higher the probability of progression of the deformity. There is also a greater risk of progression before the onset of menarche in females..."
10. Wong LPK, Cheung PWH, Cheung JPY. Curve type, flexibility, correction, and rotation are predictors of curve progression in patients with adolescent idiopathic scoliosis undergoing conservative treatment : a systematic review. Bone Joint J. 2022 Apr;104-B(4):424-432. doi: 10.1302/0301-620X.104B4.BJJ-2021-1677.R1. PMID: 35360948; PMCID: PMC9020521. "...In summary, this is the first systematic review that assessed radiological prognostic factors for AIS curve progression using the GRADE approach. We found that Cobb angle > 25° and thoracic curves are the major predictors of curve progression in unbraced patients. Thoracic curves, supine flexibility < 28%, and low in-brace correction rate predict poor outcome in braced patients. Vertebral rotation may be a promising factor despite its current low evidence. This review highlighted a few knowledge gaps in the existing literature that will benefit from future research...."
11. Nault ML, Beauséjour M, Roy-Beaudry M, Mac-Thiong JM, de Guise J, Labelle H, Parent S. A Predictive Model of Progression for Adolescent Idiopathic Scoliosis Based on 3D Spine Parameters at First Visit. Spine (Phila Pa 1976). 2020 May 1;45(9):605-611. doi: 10.1097/BRS.0000000000003316. Erratum in: Spine (Phila Pa 1976). 2020 Jun 15;45(12):E753. doi: 10.1097/BRS.0000000000003555. PMID: 31703055. "...The aim of this prospective cohort study was to improve the prediction of curve progression in AIS. By adding the 3D morphology parameters at first visit, the predictive model explains 65% of the variability...The model will help the treating physician to initiate appropriate treatment at first visit." Level of evidence: 3
12. Sun X, Wu T, Liu Z, Zhu Z, Qian B, Zhu F, Ma W, Yu Y, Wang B, Qiu Y. Osteopenia predicts curve progression of adolescent idiopathic scoliosis in girls treated with brace treatment. J Pediatr Orthop. 2013 Jun;33(4):366-71. doi: 10.1097/BPO.0b013e31827b7b5f. PMID: 23653023."...Conclusions: Osteopenia is identified to serve as a new independent risk factor in the curve progression during the duration of bracing treatment. The evaluation of initial BMD status before bracing may help to predict the outcome of brace treatment." Level of Evidence: Level II.
13. Tan KJ, Moe MM, Vaithinathan R, Wong HK. Curve progression in idiopathic scoliosis: follow-up study to skeletal maturity. Spine (Phila Pa 1976). 2009 Apr 1;34(7):697-700. doi: 10.1097/BRS.0b013e31819c9431. PMID: 19333102. "...Conclusion. Initial Cobb angle magnitude is the most important predictor of long-term curve progression and behavior past skeletal maturity. We suggest an initial Cobb angle of 25° as an important threshold magnitude for long-term curve progression. Initial age, gender, and pubertal status were less important prognostic factors in our study."

Links to Publications on Low Bone Mineral Density in AIS

The following is a curated list of links to publications.

1. Yang, Y., Chen, Z., Huang, Z. et al. Risk factors associated with low bone mineral density in children with idiopathic scoliosis: a scoping review. BMC Musculoskelet Disord 24, 48 (2023). https://doi.org/10.1186/s12891-023-06157-8 "...This scoping review showed that BMD was generally lower in children with IS than in asymptomatic controls. Genetic, endocrine, and lifestyle-related factors might be associated with low BMD in children with IS. Bone synthesis or absorption may be directly regulated by endocrine factors, while genetic and lifestyle-related factors may influence BMD via the endocrine pathway. Comprehensive screening for low BMD risk factors may be reasonable to prevent osteoporosis and progression in children with IS....
2. Llopis-Ibor CI, Mariscal G, de la Rubia Ortí JE, Barrios C. Incidence of vitamin D deficiency in adolescent idiopathic scoliosis: a meta-analysis. Front Endocrinol (Lausanne). 2023 Oct 11;14:1250118. doi: 10.3389/fendo.2023.1250118. PMID: 37886647; PMCID: PMC10598863."...The incidence rates of vitamin D insufficiency and deficiency in patients with adolescent idiopathic scoliosis were 36.19% and 41.43%, respectively. The Caucasian race was associated with a lower risk of vitamin D deficiency compared to the African race. Vitamin D deficiency was not related to curve magnitude or sex.... Vitamin D deficiency reduces the carboxylation of osteocalcin, resulting in reduced bone mineral density and osteopenia, which could make the vertebrae more susceptible to deformity and the development of AIS through the progression of the curve.."
3. Yang, Y., Han, X., Chen, Z. et al. Bone mineral density in children and young adults with idiopathic scoliosis: a systematic review and meta-analysis. Eur Spine J 32, 149–166 (2023). https://doi.org/10.1007/s00586-022-07463-w "...Conclusion Both the male and female IS patients had a generalized lower BMD and an increased prevalence of osteopenia and osteoporosis than the control group.Future research should focus on the validity of quantitative ultrasound in BMD screening. To control the risk of progression in IS patients, regular BMD scans and targeted intervention are necessary for IS patients during clinical practice.
4. Nishida M, Yagi M, Suzuki S, Takahashi Y, Nori S, Tsuji O, Nagoshi N, Fujita N, Matsumoto M, Nakamura M, Watanabe K. Persistent low bone mineral density in adolescent idiopathic scoliosis: A longitudinal study. J Orthop Sci. 2023 Sep;28(5):1099-1104. doi: 10.1016/j.jos.2022.07.005. Epub 2022 Aug 16. PMID: 35985936.
5. Wu Z, Zhu X, Xu L, Liu Z, Feng Z, Hung VWY, Cheng JCY, Qiu Y, Lee WYW, Lam TP, Zhu Z. More Prevalent and Severe Low Bone-Mineral Density in Boys with Severe Adolescent Idiopathic Scoliosis Than Girls: A Retrospective Study of 798 Surgical Patients. J Clin Med. 2023 Apr 20;12(8):2991. doi: 10.3390/jcm12082991. PMID: 37109327; PMCID: PMC10143180. "...Conclusions In conclusion, the overall prevalence of BMD Z-scores of ≤−1 and BMD Z-scores of ≤−2 in severe AIS patients were 37.5% and 8.1%, respectively. AIS boys had a significantly higher proportion of low BMD when compared with girls. Boy sex, lower BMI Z-score, serum alkaline phosphatase, and potassium were independent predictors for low BMD in the subjects. Screening and early intervention for low BMD can be considered as prophylactic measures to mitigate intraoperative blood loss and future mechanical complications....
6. Alsiddiky A, Alfadhil R, Al-Aqel M, Ababtain N, Almajed N, Bakarman K, Awwad W, Alatassi R. Assessment of serum vitamin D levels in surgical adolescent idiopathic scoliosis patients. BMC Pediatr. 2020 May 11;20(1):202. doi: 10.1186/s12887-020-02114-9. PMID: 32393207; PMCID: PMC7212606. "...Conclusion This study revealed that most AIS patients have insufficient serum vitamin D levels. Furthermore, most AIS patients are also suffering from low BMD at an early age..."
7. Li X, Hung VWY, Yu FWP, Hung ALH, Ng BKW, Cheng JCY, Lam TP, Yip BHK. Persistent low-normal bone mineral density in adolescent idiopathic scoliosis with different curve severity: A longitudinal study from presentation to beyond skeletal maturity and peak bone mass. Bone. 2020 Apr;133:115217. doi: 10.1016/j.bone.2019.115217. Epub 2019 Dec 28. PMID: 31891787.
8. Tsz Ping Lam 1, , Benjamin Hon Kei Yip 2, , Gene Chi Wai Man 1, , Wayne YW Lee 1, , Elisa Man Shan Tam 1, , Kwong Man Lee 1, , Fiona Wai Ping Yu 1, , Bobby Kin Wah Ng 1, & Jack Chun Yiu Cheng 1,Effective therapeutic control of curve progression using calcium and vitamin D supplementation for adolescent idiopathic scoliosis – a randomized double-blinded placebo-controlled trial Bone Abstracts (2017) 6 OC8 | DOI: 10.1530/boneabs.6.OC8 "...Conclusion: The results of this study provide strong evidences that calcium+Vit-D supplementation can improve bone strength in AIS. Its therapeutic effect on preventing curve progression is correlated with increase in FEA parameters, low baseline 25(OH)Vit-D level and low baseline dietary calcium intake.
9. Balioglu MB, Aydin C, Kargin D, Albayrak A, Atici Y, Tas SK, Kaygusuz MA. Vitamin-D measurement in patients with adolescent idiopathic scoliosis. J Pediatr Orthop B. 2017 Jan;26(1):48-52. doi: 10.1097/BPB.0000000000000320. PMID: 27089048."...Vitamin-D levels were lower in the AIS group, with no sex-specific effects, indicative of a possible vitamin-D resistance in AIS. Vitamin-D levels correlated positively with Ca levels and negatively with Cobb’s angle, indicative of a possible role of vitamin D in the etiopathogenesis of AIS. Patients with AIS should be monitored for vitamin-D deficiency/insufficiency..."

   Refer also to Links to Current Research.

AIS & Pregnancy:

1. Grabala P, Kowalski P, Grabala M. From Rib Hump to Baby Hump-Common Questions of Patients Suffering from and Undergoing Treatment for Scoliosis-A Comprehensive Literature Review. J Clin Med. 2024 Jun 28;13(13):3814. doi: 10.3390/jcm13133814. PMID: 38999380; PMCID: PMC11242321. “...Women who have undergone surgical procedures for AIS have been observed to exhibit a prevalence of back pain comparable with that of healthy pregnant women; however, a higher incidence of low back pain is evident when spinal fusion is extended to the L3 or L4 vertebra....The degree of correction loss during pregnancy is lower in previous reports involving pedicle screw instrumentation than in previous reports involving Harrington or hybrid segmental instrumentation....”
2. Nandoliya KR, Sadagopan NS, Alwakeal A, Kemeny H, Cloney M, Dahdaleh NS, Koski T, El Tecle N. Adolescent Idiopathic Scoliosis and Pregnancy. Cureus. 2023 Oct 10;15(10):e46782. doi: 10.7759/cureus.46782. PMID: 37954752; PMCID: PMC10633849. “...Conclusions Patients with AIS had comparable rates of c-section to the general population, and even among patients with AIS, a history of spinal fusion was not associated with an increased incidence of c-section. Adolescent idiopathic scoliosis may be associated with difficulty administering anesthesia in a minority of patients, which can lead to a lower rate of combined spinal and epidural anesthesia usage. Furthermore, most patients with AIS will experience increased back pain during and after pregnancy. Changes in Cobb angle are seen in many patients, but the clinical significance of these changes remains unknown....”
3. Theroux J, Brown BT, Marchese R, Selby M, Cope V, McAviney J, Beynon A. The impact of pregnancy on women with adolescent idiopathic scoliosis: a scoping review. Eur J Phys Rehabil Med. 2023 Aug;59(4):505-521. doi: 10.23736/S1973 9087.23.08086-3. PMID: 37746783; PMCID: PMC10548399. “...there remains a paucity of information on the effect of pregnancy on scoliosis. More robust longitudinal studies are needed to enhance our understanding and to inform health professionals who manage AIS patients. Our scoping review results may provide important information in counselling female patients with scoliosis who are contemplating pregnancy.” (Canada)
4. Cao Y, Shu S, Jing W, Zhu Z, Qiu Y, Bao H. Quality of Life During Pregnancy, Caesarean Section Rate, and Anesthesia in Women with a History of Anterior Correction Surgery for Lumbar Scoliosis: A Case-Control Study. Med Sci Monit. 2020 Oct 17;26:e926960. doi: 10.12659/MSM.926960. PMID: 33067410; PMCID: PMC7577072.