What factors are considered in deciding whether surgical treatment is indicated for adolescent idiopathic scoliosis

Indications for surgical treatment are based on curve magnitude, clinical deformity, risk of curve progression, skeletal maturity, and curve pattern. Curves greater than 50° should undergo surgical treatment because of the risk for continued curve progression in adulthood. Curves in the 40° to 50° range are analyzed on an individual basis. Curves greater than 40° with documented progression are indicated for surgery. Curves greater than 40° in skeletally immature patients (e.g. premenarchal female) should be treated surgically because of the natural history of continued curve progression with growth. Clinical deformity plays a role in decision making for select lumbar curves (35-40°). Some curves cause marked waistline asymmetry and may be considered for surgery on this basis. Sagittal plane alignment is also an important consideration. In a small subgroup of patients with severe thoracic hypokyphosis or actual thoracic lordosis, surgical treatment should be considered even if the coronal plane curve is less than 40°.

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