From Algorithms to Clinics: Recent Progress in AI for Scoliosis Diagnosis and Management

Scoliosis is a complex three-dimensional spinal deformity that requires early detection, accurate radiological assessment, individualized treatment planning, and long-term monitoring. In recent years, artificial intelligence (AI) has emerged as a promising tool across multiple stages of scoliosis management, including screening, automated imaging analysis, deformity classification, prediction of progression, surgical planning, postoperative outcome assessment, and patient education. This narrative review summarizes current and emerging applications of AI in scoliosis, with particular emphasis on studies published after 2023. Deep learning algorithms, including convolutional neural networks, U-Net-based architectures, transformer models, and generative approaches, have demonstrated high accuracy in automated Cobb angle measurement, vertebral segmentation, coronal and sagittal parameter assessment, and radiation-free screening using surface topography or smartphone-based photographs. Machine learning models have also shown potential in predicting curve progression, treatment response, risk of postoperative complications, and patient-reported outcomes by integrating radiological, clinical, biomechanical, and, increasingly, multimodal data. In parallel, large language models and generative AI tools are being investigated for patient education, communication support, readability improvement, and research hypothesis generation. Despite these advances, important limitations remain, including limited external validation, dataset heterogeneity, potential algorithmic bias, insufficient interpretability, and incomplete integration into clinical workflows. Moreover, while AI systems show strong performance in automated measurement and screening tasks, their role in complex therapeutic decision-making, such as Lenke classification, fusion-level selection, and autonomous surgical planning, remains experimental. Overall, AI has the potential to improve the precision, efficiency, and personalization of scoliosis care; however, prospective multicentre studies, transparent reporting, explainable model design, and regulatory validation are essential before widespread clinical implementation.