Diagnosing and Classifying Scoliosis: Cobb Angle, Curve Types and True vs Postural Deformity

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.

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.

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.

At 10 to 20 degrees, the focus should just be on exercises to keep the back muscles healthy and avoiding extremes of posture, that is all that is needed. Follow-up frequency with X-rays, whether every 3 months, 6 months or a year, depends on the child's age and Risser sign, not on whether they are doing exercises.

If the child is young, say 10 years old with a 20-degree deformity, X-rays should be done every 3 months since they are likely to progress more. If the child is 13-14 years old with the same 20-degree curve, X-rays every 6 months to a year are enough, just to confirm the deformity isn't progressing rapidly.

Postural scoliosis (scoliotic attitude) is a habitual standing posture, not a structural curve, distinguished from true scoliosis by standing X-rays and bending views that show whether the curve is rigid or fully correctable.

From a line along the superior end plate of the uppermost involved vertebra and the inferior end plate of the lowest involved vertebra; the angle between these two lines is the curve's magnitude.