I’m hopelessly confused about my daughter’s scoliosis. She has the adolescent idiopathic type. We just moved from California to the east coast. The surgeon in California was all set to do surgery to fuse the entire curve. The surgeon here says only the worst part of the curve needs to be fused. How is this decided?

Adolescent idiopathic scoliosis (AIS) isn’t an easy problem to treat. Just ask any orthopedic surgeon involved in the treatment of children with this condition. The cause of this type of spinal curvature in teens is poorly understood. That’s why it’s called idiopathic (unknown).

There are many spinal curve types: fixed curves, flexible curves, structural curves, major curves, minor curves, thoracic curves, thoracolumbar curves, double curves, triple curves, and so on. Finding a way to accurately evaluate and successfully treat this condition is a challenge.

One way to approach the problem is through the use of a classification system. Such a system helps define the location, type, and severity of the spinal curve. The goal is to direct treatment so that children with the same problem get the same treatment. A secondary goal is to guide surgical treatment (when fusion is needed).

The underlying desire of treatment is to save as much motion and flexibility as possible. The surgeon gives consideration to the need for good alignment, posture, function, and cosmetics (appearance). Sometimes there’s a fine line between correcting the spinal deformity while preserving flexibility.

Recommendations may differ based on geographical location (east versus west), the way the surgeon was trained, and the tools used to evaluate the curve. For example, there are three different systems used to classify and guide treatment: the Cobb system, the King system, and the Lenke system. Each one takes a slightly different approach.

The oldest system in use is the Cobb method. The most recent one is the Lenke system (developed in 2001). The King classification system may be the least commonly used system as researchers have questioned its reliability. Depending on which method your two surgeons used, you might get two different treatment recommendations.

In a situation like this, you may want to get a third opinion. You can certainly ask the two surgeons involved to consult with one another in order to help you understand treatment recommendations — and of course, make the best treatment plan possible for your daughter.