summary Juvenile Idiopathic Scoliosis is a coronal plane spinal deformity which most commonly presents in children between ages 4 and 10. Diagnosis is made with full-length standing PA and lateral spine radiographs. MRI studies are indicated in children <10 years old with a curve > 20°. Treatment can be observation, bracing, or surgical management depending on the skeletal maturity of the patient, magnitude of deformity, and curve progression. Epidemiology Incidence 15% of all idiopathic scoliosis cases Demographics females > males Anatomic location most commonly appear as a right main thoracic curve Etiology Associated conditions high incidence of neural axis abnormalities (18-25%) syringomyelia login to view 3 more bullets Arnold-Chiari syndrome login to view 1 more bullet tethered cord dysraphism spinal cord tumor Classification Early onset scoliosis (EOS) early-onset scoliosis is a broader category including scoliosis in children <10 years old. It includes infantile idiopathic scoliosis juvenile idiopathic scoliosis congenital scoliosis neurogenic scoliosis syndromic scoliosis login to view 2 more bullets Presentation History important to determine when deformity was first noticed and any observed progression get perinatal history Presentation failure to develop bowel and bladder control by age ~ 3 or 4 may indicate neurologic involvement patients often referred from school screening where a 7° curve on scoliometer during Adams forward bending test is considered abnormal 7° correlates with 20° coronal plane curve Physical exam general inspection cafe-au-lait spots (neurofibromatosis) leg length inequality shoulder height differences truncal shift waist asymmetry and pelvic tilt foot deformities (cavovarus) login to view 1 more bullet spine inspection midline skin defects login to view 3 more bullets rib rotational deformity (rib prominence) Adams forward bending test login to view 1 more bullet forward bending sitting test login to view 1 more bullet neurologic motor login to view 1 more bullet reflexes login to view 6 more bullets gait analysis Imaging Radiographs PA and lateral upright images are used to assess curve severity treatment based on Cobb angle Cobb angle > 10° defined as scoliosis intra-interobserver error of 3-5° bending radiographs can help determine which curves require fusion MRI indicated in children <10 years old with a curve > 20° even in the absence of neurologic symptoms must rule out neural axis abnormalities (e.g., syringomyelia) presence of left-sided thoracic curve Treatment Nonoperative observation indications login to view 1 more bullet technique login to view 1 more bullet bracing indications login to view 3 more bullets technique login to view 1 more bullet Operative non-fusion procedures (growing rods, VEPTR) indications login to view 3 more bullets traditional growing rods associated with greater curve correction and truncal height gain than VEPTR constructs requires additional lengthening procedures anterior / posterior spinal fusion indications login to view 2 more bullets posterior spinal fusion indications login to view 2 more bullets anterior spinal fusion indications login to view 2 more bullets Complications Crankshaft phenomenon Prognosis High risk of progression 70% require treatment (50% bracing, 50% surgery) Very few experience spontaneous resolution Growing rod constructs found to improve pulmonary function parameters and diaphragmatic motion Can be fatal if not treated appropriately