Adolescent idiopathic scoliosis is the primary cause of three-dimensional spine deformities. It is officially defined by the Scoliosis Research Society as a spinal deformity characterized by a coronal Cobb angle exceeding 10° (1). Adolescent idiopathic scoliosis is an abnormal curvature of the spine that occurs in late childhood or adolescence (2, 3). Adolescence is a pivotal period marked by self-perception and self-esteem development, a time when developmental changes such as scoliosis can profoundly impact both the physical and mental health of young individuals. This stage of life is particularly sensitive to psychological development, with research indicating that adolescents with scoliosis are more susceptible than adults to experiencing psychological distress. Such distress can significantly diminish their quality of life (4). Therefore, it is necessary to conduct in-depth research on the treatment of adolescent idiopathic scoliosis.

Adolescent Idiopathic Scoliosis (AIS) is a common spinal deformity in adolescents, with treatment options varying based on individual differences. Current methods primarily include observation, bracing, physical therapy, and surgical intervention. Observation is suitable for patients with mild curvature, and when combined with sensors, it allows for real-time monitoring. Bracing treatments utilize innovative technologies like 3D printing and dynamic braces to enhance comfort and effectiveness (5). Physical therapy can incorporate virtual reality to assist with posture correction. Surgical treatments focus on minimally invasive techniques and navigational applications, improving both safety and correction outcomes (6). Additionally, the application of biomaterials and robotic technologies offers emerging treatment options. By integrating genetic analysis and intelligent algorithms, precise predictions of disease progression and personalized treatment plans can be achieved. The application of new technologies is advancing the scientific and individualized approach to AIS treatment.

While numerous scholars have explored adolescent idiopathic scoliosis, the field lacks comprehensive visualization analysis, hindering the identification of current research trends and future directions. Visual research methodologies can illuminate rigorous data, uncover research hotspots and frontiers, and offer detailed insights into the dynamic development and overall structure of the field. This paper seeks to bridge this gap by employing bibliometric and visual analysis to summarize the current landscape, highlight hotspots, identify emerging trends, and delineate frontiers in global research on adolescent idiopathic scoliosis. The findings aim to provide theoretical foundations for future investigations in related areas.

This article employs bibliometric analysis to elucidate the landscape of adolescent idiopathic scoliosis treatment, shedding light on its current status, focal areas, and emerging frontiers. Over the decade spanning from 2009 to 2019, the volume of publications in this domain remained relatively stable, with a discernible uptick observed from 2020 onwards, culminating in a peak in 2022.

These scholarly contributions predominantly find their place in journals specializing in scoliosis research, with Spine emerging as the primary outlet for dissemination. Notably, the United States and China, alongside various academic institutions, stand out as the leading contributors, showcasing both the highest publication output and significant influence in the realm of adolescent idiopathic scoliosis research literature. This comprehensive analysis provides valuable insights into the trajectory and geographical distribution of research efforts in this critical area of healthcare.

Newton, Peter O emerges as the most prolific author in this field, having published the largest number of papers. However, while there are some network links between authors, the overall collaboration is relatively limited and dispersed. This suggests a low level of collaboration among authors, albeit with scattered connections, indicative of a lack of consistent and stable partnerships. The current research hotspots in adolescent idiopathic scoliosis (AIS) focus on the relationship between the quality of life of AIS patients and various treatments, including Schroth exercises, vertebral body tethering, and growth modulation. There is also an emerging interest in fusion-related treatments, suggesting a possible new trend in future studies.

The United States leads in this field, holding the most central position with the highest number of publications. It is followed by China and Canada, with China and Turkey being the only developing countries among the top 10 in terms of publication count. This highlights the prominence of developed countries in AIS research, with their more robust healthcare infrastructure and research funding. At the same time, the presence of developing countries among the top contributors indicates a growing global interest in scoliosis treatment research. Developed countries, such as the United States, have better economic conditions than developing countries, and their residents enjoy higher access to insurance plans and better economic standards (7). In developed countries, patients with conditions like scoliosis may have greater access to healthcare services, including specialized treatments and participation in research studies. This increased access can lead to more active involvement in scoliosis research and publication activities compared to patients in developing countries, where healthcare resources and research opportunities may be more limited.

Therefore, we recommend that scholars from China and Turkey, especially the former, conduct more collaborative research with other developed countries. Most of the top 10 institutions are from the United States, and 60% are universities. The network map of collaboration between institutions and authors is relatively fragmented. A growing body of evidence suggests that more inter-agency communication and collaboration between authors may be associated with higher research productivity and research quality (8, 9). Therefore, it is necessary to expand the network of cooperation between institutions and authors, especially with American universities.

Keyword clustering is a valuable technique for summarizing the core and hot spots within a research field. In the realm of AIS treatment, three prominent areas emerge as hot spots: Cobb angle measurement, the efficacy of non-surgical treatments, and the influencing factors affecting the success of brace treatment. At present, there are three main research directions in this field: interventions, influencing factors, and prognostic outcomes, but there are few studies on how to choose treatment methods based on different regions and different ethnic groups.

Notably, the Cobb angle is the most popular topic. The Cobb angle plays an important role in the diagnosis and treatment of adolescent idiopathic scoliosis and is not diagnosed until the Cobb angle exceeds 10° on standing spinal x-rays (10). Severe curvature of the Cobb angle >50° should be surgical (11). Patients with immature bones with a Cobb angle of ≥25° should use a brace to prevent or delay scoliosis progression. There is prognostic uncertainty about the Cobb angle of <25° and the growth of remaining bone, and doctors use a watchful waiting strategy (12). At present, there are three main types of intervention for Cobb angle: surgical treatment, brace treatment, and conservative treatment. In the actual treatment process, the best treatment plan should be selected according to the actual situation of the patient. Other treatments, such as enriched bone marrow obtained by selective cell preservation technology, have a positive effect on the treatment of adolescent idiopathic scoliosis and the improvement of the Cobb angle. However, the intensity, duration, and duration of treatment need to be further verified. Researchers should conduct high-quality randomized controlled trials of different treatment regimens to provide the most effective treatment to improve the Cobb angle (7–13). Other treatments, such as enriched bone marrow obtained by selective cell preservation technology, have a positive effect on the treatment of adolescent idiopathic scoliosis and the improvement of Cobb angle (14), but the intensity, duration, and duration of treatment need to be further validated. Researchers should conduct high-quality randomized controlled trials of different treatment options to provide the most effective treatment to improve the Cobb angle.

Another hot topic is the Efficacy of non-surgical treatment of AIS. However, due to the high risk and high cost of surgical treatment, non-surgical treatment has gradually become the primary choice, especially for patients with mild initial scoliosis, exercise therapy is a more effective and preventive method for scoliosis (15). At present, there are two types of exercise therapy, one is general exercise therapy, which mainly includes lower-intensity stretching exercises and strength training, which can stabilize the condition and alleviate the condition to a certain extent (16). The other approach is Physiotherapy Scoliosis Specific Exercise (PSSE), which focuses on preventing the development of scoliosis and is recommended by the SOSORT Association as the first step in the treatment of mild AIS (17). Through many high-quality studies, it has been found that PSSE is superior to general exercise therapy in correcting Cobb angle in AIS patients, but PSSE also has its disadvantages, especially in improving deformity, its efficacy is not as good as that of brace therapy, but compared with brace treatment, PSSE has obvious advantages in relieving pain and improving patients' mental health (18).

The third hotspot is the factors affecting the success of brace treatment, AIS is a relatively common disease, and there are two main treatment methods: surgical treatment and non-surgical treatment. Brace therapy has been shown to be one of the most effective non-surgical treatments (19). However, the success of brace therapy is affected by a variety of factors, among which adherence is the most important factor, and maintaining a high degree of adherence is the basis for the success of brace therapy (20). Increasing patient brace compliance during treatment can improve treatment outcomes (21). The length of time the brace is worn is also an important factor. It has been reported that factors associated with bracing may interfere with various aspects of a patient's health, negatively impacting the patient's daily life (22). Therefore, wearing a brace for a longer period each day may lead to a further decline in the quality of life of patients with AIS, which in turn affects patient compliance and thus disease progression (23). In addition to this, the main factors include the patient's low skeletal maturity and the initial Cobb angle >30° (24).

The emergence of keywords and the trend of their changes can reflect the development history and frontier of research. The process of this study can be divided into three processes. This study summarizes two research trends. The relationship between the first curvature and prognosis. To date, the effectiveness of school-age screening remains controversial in relevant studies, and it is uncertain what curvature can progress after diagnosis until the stage where treatment is needed (25). In response to this, research on the prognosis of adolescent idiopathic scoliosis has attracted increasing attention to guide the initiation of treatment (26). For brace therapy in particular, different curvatures have an important impact on the success of brace therapy (27). Future studies need to be carefully designed to explore the relationship between different curvatures and prognosis. Second, research on the etiology of adolescent idiopathic scoliosis. Current theories regarding the etiology of adolescent idiopathic scoliosis include genetic, metabolic, biomechanical, and environmental theories (28). At present, the pathogenesis of adolescent idiopathic scoliosis is mainly biomechanical, but there is a lack of accepted mechanistic theories (4, 25, 26, 28–30). In terms of genetic factors, although genetic factors are currently thought to play an important role in adolescent idiopathic scoliosis, this factor has considerable specificity (31, 32). Current research into the etiology of adolescent idiopathic scoliosis is complicated by the suspicion that it is not caused by a single cause, but by the interaction of multiple causes (4, 30–34). For adolescent idiopathic scoliosis, a better understanding of the underlying etiological mechanisms associated with it can lead to a better diagnosis of the disease and accurate prediction of deformity progression, helping patients achieve the best clinical outcomes (35).

This study carried out a comprehensive analysis focusing on various aspects such as the volume of annual publications, journal contributions, contributing countries, institutions, and authors, as well as keyword clustering and prominence. Through this analysis, we have charted the trends in annual publication volumes over the past fifteen years and identified the journals with the highest number of contributions. The findings suggest that enhanced collaboration among different countries, institutions, and authors is crucial. By examining keyword clustering and prominence, we have pinpointed current research hotspots and anticipated future research directions.

This study acknowledges certain limitations. Firstly, the search was confined to publications from the WoSCC database, excluding literature from other significant databases such as PubMed or Embase relevant to adolescent idiopathic scoliosis treatment. While each database has unique characteristics, combining papers from multiple sources can offer a more thorough understanding of the topic. While the WoSCC database is highly respected and contains prestigious academic journals, it's essential to consider literature from additional sources to ensure a comprehensive review. Secondly, due to constraints with CiteSpace software, this study only encompasses English articles published within the last fifteen years, potentially missing out on valuable research published in other languages or before the specified timeframe. This limitation might impact the study's breadth and applicability. To mitigate these limitations, future research could expand the search to encompass multiple databases and languages. Additionally, employing alternative bibliometric analysis tools could enhance the comprehensiveness of the review of adolescent idiopathic scoliosis treatment literature.

The study you're referring to analyzed a total of 1,002 English-language articles focused on the treatment of AIS from 2009 to 2022. It observed that while publication volume remained low and stable until 2020, there was a noticeable increase starting in 2021, with the highest number of publications recorded in 2022. This trend suggests a growing interest and development in the field of AIS treatment during these years. The analysis highlighted that the United States led in terms of contributions, with significant input from both Nanjing University and Peter O. Newton, identified as the most prolific institution and author, respectively. The journal “Spine” was noted as the primary publication venue for research in this area. Research hotspots identified include the Cobb angle, the efficacy of non-surgical treatments for AIS, and factors influencing the success of brace treatment. These focus areas have been crucial in understanding and advancing treatment strategies for AIS. The paper also points out emerging trends in the research, particularly the relationships between spinal curvature and patient prognosis, as well as the underlying causes of AIS. Investigating these areas could lead to innovative treatment approaches and more tailored care plans, potentially improving outcomes for those with AIS. The study underscores the importance of translating these research findings into clinical practice and serves as a valuable resource for scholars aiming to further explore AIS treatment strategies. This kind of research is vital not only for expanding scientific understanding but also for enhancing practical applications that benefit patients directly.