Adolescent idiopathic scoliosis: etiology, anatomy, natural history, and bracing.

Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine. Despite active efforts by different research teams, the etiology of scoliosis remains unclear. Treatment of scoliosis requires a solid understanding of the natural history of the disorder as well as sound clinical judgment. The evaluation, monitoring, and institution of conservative treatment such as bracing can present a challenge to the orthopaedic surgeon. Clinical monitoring is the only intervention necessary in most patients. A detailed review of the patient's history as well as a careful physical examination can help establish the diagnosis and the risk for progression. Skeletal maturity, gender; growth velocity, curve location, and magnitude are factors that can help assess the likelihood of progression. Bracing is the only nonsurgical measure proven to have any effect on halting the progression of scoliosis. Other forms of conservative treatment have not been shown to significantly modify the natural history of idiopathic scoliosis. Bracing results are directly related to compliance with brace treatment; therefore, optimal results cannot be achieved without the patient's cooperation and family support.