The Evidence Base for the Prognosis and Treatment of Adolescent Idiopathic Scoliosis: The 2015 Orthopaedic Research and Education Foundation Clinical Research Award

We present a summary of our research into the natural history and treatment of adolescent idiopathic scoliosis (AIS). This work has answered critical clinical questions and in aggregate has substantially contributed to the evidence base for the prognosis and treatment of AIS. Evidence-based practice has been defined by Straus and Sackett1 as the best research evidence when combined with clinical experience (based on knowledge and experience developed over time from practice, including inductive reasoning) and patient circumstances. The first step in pediatric evidence-based practice is to understand the natural history of the disease or condition in order to learn the adult consequences of the condition. We need to understand what we are trying to prevent with treatment. The second step is to determine the outcomes of treatments to establish that treatment has favorably altered the natural history without introducing iatrogenic complications. The focus of our research over the last thirty-eight years has been to establish the evidence base for a variety of pediatric orthopaedic conditions. We present an overview of our research contributing to the current evidence for the prognosis and treatment of AIS. Arthur Steindler, MD, cared for a large number of patients with AIS between 1932 and 1948 and kept meticulous records of their initial presentation and subsequent visits. Our research was possible because of these records and the loyalty of these patients to Dr. Steindler and the University of Iowa. AIS is characterized by a lateral curvature of the spine of 10° or greater with rotation of the vertebrae. The diagnosis is made when other causes of scoliosis have been ruled out. Two to three percent of children younger than sixteen years of age will have a curvature of 10° or greater, and 0.3% to 0.5% will have a curvature of 20°, the size at which …