Introduction:
Clearly manifested neurological symptoms in patients with idiopathic scoliosis (IS) are disputable, and their severity probably depends on the progression of the curvature. Their incidence and how they may affect treatment decisions have not been clearly defined in the current literature. The purpose of this paper was to present the prevalence of neurological symptoms in scoliotic patients qualified for surgical treatment, based on the available reports and the own observations on this topic.

Methods and results:
Mostly, during neurological evaluation of the scoliotic patients the researchers have documented the average results of Oswestry Disability Index (ODI), abnormalities in radiographic findings, the increased incidences of back pain, radiculopathy, myelopathy and less claudication, and neurological deficits like pain, muscle weakness and less bowel/bladder dysfunction and correlated these findings with operative versus non-operative management. The incidences of severe (Visual Analogue Pain Score – VAS > 5) back pain and radiculopathy were 66% and 47%, respectively. Typical neurological symptoms included muscle weakness in 8% of patients and less claudication, while bladder dysfunction occurred in 3%. Patients with severe radiculopathy had greater mean ODI scores (p < 0.001) and reduced lumbar lordosis (p = 0.04) and were more likely to develop lateral spine curvature (p = 0.009). Reflexes evaluation was mentioned but not precisely described. Our preliminary observations on 60 preoperative cases of Lenke 2 and 3 scoliosis with an average primary and secondary curvature angle of 56 degrees and 35 degrees indicate back pain of 2 on the VAS scale, a low incidence of positive Laseque test and suppression of knee and ankle reflexes, symptoms of slight analgesia in the dermatomal innervation of L3-S1, and decreased muscle strength of the distal lower extremities on the Lovett scale of 4.

Conclusions:
Neurological symptoms of back pain, moderate muscle weakness and sensory deficits are common among adults with scoliosis. The development of neurological symptoms and/or deficits significantly influences the decision on surgical treatment. More precise clinimetric methods and clinical neurophysiology tests are necessary to define the neurological symptoms of IS, which are difficult to evaluate using classical assessment methods.