Principal Director, Orthopaedics, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi
Series overview · 8 articles
Adolescent Idiopathic Scoliosis
August 4, 2024
Adolescent idiopathic scoliosis is the most common spinal deformity in young people, and the central diagnostic challenge is that its cause is genuinely unknown: it isn't congenital, neuromuscular, or clearly hereditary in most cases, which is exactly why it carries the label idiopathic. Dr. Manoj Miglani, Principal Director, Orthopaedics at Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, used his Jivo Masterclass to walk through how the deformity is diagnosed, classified and monitored, when observation is enough versus when bracing or surgery is warranted, and fielded a genuinely detailed set of questions, including a real patient case shared live during the session.
A session with real cases and real numbers
Doctors on the call, from Ethiopia, the DRC, Zambia, Nigeria, Mozambique and beyond, asked pointed questions on bracing duration, surgical complication rates, intraoperative monitoring, and one doctor shared a personal case of post-traumatic scoliosis for live guidance. This guide introduces a series built around both the core lecture and that discussion.
What this series covers
This series works through what adolescent idiopathic scoliosis is and why its cause remains unknown, how the Cobb angle and curve classification are used to diagnose and describe a curve, how the Risser sign predicts whether a curve will progress, the thresholds for observation versus bracing versus surgery, why bracing has real practical limits, the evolution of surgical correction from early rod systems to modern pedicle screw fixation, and the real complication rates and questions raised during the session.
This article is based on a Jivo Masterclass session conducted by Dr. Manoj Miglani, Principal Director, Orthopaedics, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Manoj Miglani taught doctors across Africa on August 4, 2024.
FROM THE LIVE Q&A
Dr. Michel Kabongo Ngoy
Is there a difference between true scoliosis and scoliosis attitude?
Dr. Manoj Miglani
Yes. Scoliotic attitude is purely a postural thing, not a structural curve. A true structural curve is distinguished from a postural presentation using standing X-rays and bending views, which show whether the curve is rigid or fully correctable.
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Frequently Asked Questions
As a traumatic scoliosis patient from DRC with a Cobb angle of 22 degrees, should I wear a custom-made corset or a removable corset with physiotherapy sessions?▼
At a Cobb angle of 22 degrees, correction may not be needed at all. If there is no pain in the affected area of the spine, the curve is unlikely to progress further and has likely already stabilised, so no bracing or active intervention is required. X-ray pictures and clinical photos would be needed for a fuller review of the specific case.
Can you say something regarding intraoperative monitoring during operative treatment of AIS?▼
Intraoperative neuromonitoring is used routinely for curves more than 60-70 degrees, which makes the surgery much safer. The monitoring system stays active throughout the procedure, with checks after every screw placement and after every corrective manoeuvre, which is what keeps neurological complication rates under 1%, even for nerve root injury.
When treating AIS with bracing: how many hours per day should a brace be worn, what are the indications for considering the treatment a failure, and when should surgical options be considered after failure of bracing as non-operative management?▼
A brace should be worn for 22 hours a day to be effective. Treatment is considered a failure if the deformity progresses both clinically and radiologically despite bracing. Surgery should be considered once the child has more than 40 degrees of deformity with growth still remaining.
What are the most common complications after surgical management of scoliosis, and how are they prevented?▼
Routine complications similar to other major surgeries: bleeding, infection, paralytic ileus, and malposition of hardware. Specific rates are neurological injury under 1%, respiratory complications 2-8%, infection under 1%, and mesenteric artery issues around 2.7%, kept low through routine intraoperative neuromonitoring and surgical volume/experience at the centre.
Is adolescent idiopathic scoliosis hereditary?▼
Around 30% of adolescent idiopathic scoliosis cases have a family member with scoliosis, suggesting some hereditary or familial component, though it's far from universal. Congenital scoliosis and some neuromuscular or syndromic forms of scoliosis have a much stronger chance of being hereditary, since they involve clearer genetic transmission.
What does this masterclass series cover?▼
Diagnosis and classification of adolescent idiopathic scoliosis, the Risser sign, treatment thresholds (observation, bracing, surgery), bracing limitations, the history of surgical correction techniques, and complication rates.
Who is Dr. Manoj Miglani?▼
Principal Director, Orthopaedics at Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi.
In This Series: Adolescent Idiopathic Scoliosis
- 1.Adolescent Idiopathic Scoliosis
- 2.What Is Adolescent Idiopathic Scoliosis? Epidemiology and the Unknown Cause
- 3.Diagnosing and Classifying Scoliosis: Cobb Angle, Curve Types and True vs Postural Deformity
- 4.The Risser Sign: Predicting Whether a Scoliosis Curve Will Progress
- 5.Treatment Thresholds: Observation, Bracing and Surgery by Curve Severity
- 6.Why Bracing Has Real Limits: Brace Types, Compliance and When It Fails
- 7.Surgical Correction: From the Harrington Rod to Modern Pedicle Screw Fixation
- 8.Scoliosis Complications: Untreated Progression, Surgical Risk and a Post-Traumatic Case