Long-Term Management of Adolescent Idiopathic Scoliosis in Adulthood: Clinical Challenges and Progress During the Critical Period of Pregnancy

Adolescent idiopathic scoliosis (AIS) is the most common three-dimensional spinal misalignment, with its impact often extending into adulthood and presenting a range of long-term health challenges. This review focuses on the long-term management strategies for adult patients with AIS and explores the unique physiological event of pregnancy and its influence on disease progression, clinical symptoms, and treatment decisions. We systematically analyze the natural history of adult AIS, the evolution of pain and functional impairment, and radiographic progression patterns. Special emphasis is placed on biomechanical changes of the spine and pelvis during pregnancy and postpartum, pain management approaches, delivery mode selection, and potential effects on offspring. By integrating current evidence and recent research findings, this review synthesizes key insights: the progression of AIS in adulthood is typically slow but can be exacerbated by factors such as significant curve magnitude at skeletal maturity; pregnancy does not consistently accelerate curve progression but may intensify pain and functional limitations, necessitating tailored multidisciplinary management; and evidence supports that most women with AIS can undergo vaginal delivery without increased obstetric risk, while anesthetic and analgesic planning requires careful consideration of spinal anatomy. This review aims to provide evidence-based guidance and clinical recommendations for comprehensive lifelong health management of this special patient population.