Abstract
Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.
Highlights
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity with potential adverse long-term physical and psychological impact on young patients
Many adults are presenting for scoliosis surgery who still remember their childhood years spent in casts and turnbuckle braces
We suggest that surgical and non surgical treatment option each has their rightful place and that the decision for treatment should be based on the curve type and the risk factories for progression, keeping in mind the end result as well as the expected long-term outcomes
Summary
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity with potential adverse long-term physical and psychological impact on young patients. Fifty year follow up of 117 patients with untreated AIS (average curve magnitude > 75° for thoracic, thoracolumbar, and double major curve patterns) demonstrated no increase in mortality rates, disabling back pain, and ability to complete daily activities compared to age and gender matched controls [18]. Adolescents treated surgically for AIS demonstrate significant improvement in HRQL measures compared to preoperative scores, including improvement in all SRS questionnaire preoperative domains at 2 year follow-up, and report high treatment satisfaction levels [26]. Pain scores at 5 year follow up were still lower than preoperative values, and patients continued to reported high treatment satisfaction and high self-image, independent of the pain scores
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