Treatment Thresholds: Observation, Bracing and Surgery by Curve Severity

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.

No, there are no preventive measures for idiopathic scoliosis, because the actual cause isn't known. The only genuinely useful advice is for the child to stay physically active, which most children naturally are.

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.

Once a curve exceeds 40-45 degrees with a clinically obvious deformity in a skeletally immature patient, or once a mature patient's curve is already over 45 degrees and clinically problematic.

When the deformity continues to progress both clinically and radiologically despite bracing, and especially once it exceeds 40 degrees with growth still remaining, at which point surgery is the better option.