# From a biomechanical perspective: pathogenesis, clinical manifestations and treatment strategies of adolescent idiopathic scoliosis

## TL;DR

This review explains how biomechanics influence the causes, symptoms, and treatments of adolescent idiopathic scoliosis, offering a new framework for understanding and managing the condition.

## Contribution

The paper introduces a biomechanical framework that unifies the understanding of AIS from molecular to macro levels, guiding clinical treatment strategies.

## Key findings

- AIS pathogenesis involves a 'vicious cycle' of biomechanical imbalances between passive, active, and neurocontrolled subsystems.
- Biomechanical factors drive the progression of minor spinal imbalances into significant three-dimensional deformities.
- Treatment strategies for AIS, including bracing and surgery, fundamentally rely on biomechanical correction principles.

## Abstract

Adolescent Idiopathic Scoliosis (AIS) is a complex three-dimensional spinal deformity, and its etiology and progression mechanisms have not been fully elucidated. This review aims to comprehensively explain the pathogenesis, clinical manifestations, and treatment strategies of AIS from a biomechanical perspective, providing a new theoretical framework for clinical diagnosis and treatment.

This review strictly follows the PRISMA guidelines for systematic literature search and selection. The search databases include PubMed, Embase, Web of Science, and Cochrane Library, with the cutoff date being June 2025. The search strategy involves a combination of keywords related to AIS, biomechanics, pathogenesis, clinical manifestations, and treatment. By progressively screening titles, abstracts, and full-text articles, relevant high-quality studies were ultimately included for comprehensive analysis.

The pathogenesis of AIS can be conceptualized as a “vicious cycle” driven by the interactional imbalance between passive subsystems (skeletal-ligament), active subsystems (muscles), and neurocontrolled subsystems (central and peripheral nerves). Biomechanical factors play a key role in driving the progression from initial minor imbalances to significant three-dimensional deformities. Clinically, symptoms such as body deformity, back pain, and reduced cardiopulmonary function can all be directly interpreted from a biomechanical perspective. In terms of treatment, all mainstream interventions (including observation, specific exercise rehabilitation, bracing, and surgery) fundamentally rely on biomechanical correction.

The biomechanical perspective provides an indispensable integrative framework for understanding AIS. It unifies the process from molecular abnormalities to macro deformities, linking the diverse clinical manifestations and treatment approaches. Further exploration of biomechanical mechanisms is of significant importance for optimizing treatment timing and improving long-term patient outcomes.