Adolescent Idiopathic Scoliosis

WHEN a patient asks me, ‘What does idiopathic mean?’ I usually respond: ‘The doctoir is an idiot and the patient pathelic’. While we cannot admit we are idiots., we can admit our ignorance of the etiology of scoliosis after excluding the congenital and paralytic types. The patient, however, needs to know that she or he is not really pathetic inasmuch as the condition is neither life threatening nor seriously disabling unless the curve exceeds 50 degrees at skeletal maturity, since the curve can increase 1 degree per year throughout life’. At 70 degrees clinicians have reported decreasing pulmonary function and oxygen saturation, with eventual right-sided heart failure2. Although adults who have moderately severe untreated scoliosis can complain of back pain, the data from long-term studies indicate that the incidence of low back pain is no greater in the scoliotic person than in the general population3 5 . Certainly, the rib hump deformity in the usual right thoracic curve and/or deconipensation of the curve with a shift of the trunk in the thoracolumbar or lumbar curve are visible deformities in the naked person, and are particularly disturbing to the body image of the adolescent girl who perceives a less than perfect body. On the other hand, balanced double major curves (right thoracic and left lumbar equal in degrees) have no obvious gross trunk deformity when standing erect. My test on appearance is to have the patient garbed in a halter and trunks, bikini bathing-suit style, and then to view her from a distance of 15 to 20 feet. Then I ask whether her back looks deformed. The next question regarding a patient with newly-discovered idiopathic scoliosis is whether it can be treated and, if so, is treatment effective? A perspective on the answer to this question was sent to me by \o p’