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. 2024 May 8;61(7):666–676. doi: 10.1136/jmg-2023-109667

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© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Illustration of carbohydrate metabolism dysfunction on severe adolescent idiopathic scoliosis (AIS) across life stages. This figure illustrates the evolution and progression of severe AIS, triggered by a generalised dysfunction in carbohydrate metabolism. The ‘Initiation Phase’ marks the early onset of AIS, reflecting the impact of metabolic disturbances. The ‘Progression Phase’ underlines the swift progression of scoliosis during periods of typical growth spurts in preteens and teens. The ‘Challenge Phase’ in adulthood encapsulates the enduring struggle with the disease, marked by increased risks of spinal degeneration, chronic pain, cardiopulmonary complications and diminished quality of life. Environmental factors exert influence throughout all these stages. The figure was created by BioRender.com.