A comprehensive narrative review of scoliosis in children and adolescents: epidemiology, screening strategies, therapeutic interventions, and biomechanical research

Scoliosis in children and adolescents, particularly adolescent idiopathic scoliosis (AIS), is a complex three-dimensional spinal deformity with a well-defined global prevalence and a considerable disease burden. This narrative review synthesizes the latest advances in the field, encompassing epidemiology, screening strategies, conservative treatment (bracing and physiotherapeutic scoliosis-specific exercises), biomechanical research, and artificial intelligence applications. A recent global meta-analysis indicates that the overall prevalence of scoliosis in children and adolescents is approximately 1.65%, with a consistent female predominance observed across most studies (global pooled OR = 2.16, 95% CI: 2.01–2.33), although the magnitude of this sex disparity varies by region, and prevalence increasing with age. However, the included studies are geographically unbalanced, with limited data from low-latitude regions, which may bias the global prevalence estimate. School-based screening remains the cornerstone of early detection, but screening policies vary significantly across countries. The development of novel home-based screening tools offers a new approach to overcome the limitations of school screening, yet their widespread adoption is constrained by economic factors and parental awareness. Multiple randomized controlled trials and meta-analyses have confirmed the efficacy of bracing and physiotherapeutic scoliosis-specific exercises, but no unified clinical guidelines exist for selecting the optimal treatment strategy. Furthermore, long-term longitudinal evidence on the intrinsic link between treatment approaches and patients’ mental health is still lacking. In addition, biomechanical techniques such as finite element analysis provide new perspectives for elucidating the mechanical properties of scoliosis and optimizing treatment strategies, but most models are constructed under idealized conditions, differing from the physiological state, and their clinical translational value awaits further validation. This review integrates core evidence from the field, aiming to provide a reference for clinical practice and future research directions.