Which intervention is most appropriate for a 12-year-old with progressive idiopathic scoliosis and a Cobb angle of 45°?

• A. Orthotic management
• B. Postural correction
• C. Surgical intervention
• D. Spinal stabilization exercises

Answer: (C)

In growing children with idiopathic scoliosis, the bigger the curve and the more it progresses, the more likely surgery becomes the best option. A Cobb angle around 45 degrees in a 12-year-old means the spine is already significantly deformed and still growing, so simply wearing a brace or doing exercises is unlikely to stop the curve from getting worse.

Bracing is most effective for moderate curves in skeletally immature patients to slow progression, but as the curve approaches mid-40s and continues to progress, bracing often cannot halt the deformity. Exercises or posture-focused approaches can help with strength or flexibility but cannot correct a structural, growth-related spinal curve.

Surgical intervention aims to stop progression and stabilize the spine, with the potential for realignment and improved cosmetic appearance. In a young patient, the typical approach is posterior spinal fusion with instrumentation to hold the correction, sometimes using growth-friendly techniques to preserve as much spinal growth as possible.

So, the best choice is surgical stabilization to halt progression and correct deformity in a growing child with a large, progressing curve.