Idiopathic Scoliosis - Infantile; Juvenile;
Adolescent
Idiopathic scoliosis is
considered in three age groups: Infantile--from birth to three years of
age, juvenile--from greater than three years of age through nine years of
age and, adolescent from 10-18 years of age. The adolescent type is the
most common and represents about 80% of this type of scoliosis. In
addition to the amount of spinal deformity, the patient's physiological
age is assessed, i.e., is growth completed or is there more potential
spinal growth.
In the latter case,
potential curve progression is related to the time remaining until
maturity. Curve progression is often associated with degenerative
intervertebral disc disease and degenerative joint disease of the spine in
middle-aged or older patients or may be due to significant previously
present undiagnosed or untreated scoliosis.
Idiopathic scoliosis
treatment is patient-age dependent. In patients with infantile scoliosis
(0-3 years) left-sided curves are commonly seen, particularly in boys and
may resolve spontaneously with growth.
Observation treatment
is done with repeat evaluation every four to six months. Use of orthoses
(braces) and surgery is uncommon. Juvenile idiopathic scoliosis (3-9 year
olds) may rapidly progress especially in children over the age of five and
may require orthotic (brace) management.
Surgery is indicated if
the curve is unable to be controlled by orthotic means. Although surgery
in a significantly skeletally immature spine will produce some decrease in
ultimate spine height, it is better to have a shorter spine with more
normal alignment than a progressive curve where height is lost because of
deformity.
The most common of all
types of scoliosis is adolescent idiopathic and is seen with equal
frequency in boys and girls at low curve magnitudes. Girls, for unknown
reasons, have a significantly higher risk for development of curve
progression than boys. Pulmonary and cardiac function are not impeded with
lumbar curves and significant changes of pulmonary function are not seen
in patients with thoracic curves until the curve reaches a level greater
than 70? , i.e., a severe curve. This amount of curve and subsequent
cardiac and pulmonary changes are often seen later in life in untreated
idiopathic infantile and juvenile scoliosis patients and present a threat
to life. Patients with adolescent onset idiopathic scoliosis do not
usually have such compromise unless severe curves develop. The time of
highest risk for curve progression in adolescent idiopathic scoliosis
occurs around puberty, i.e., when the growth rate is the fastest.
Pulmonary and cardiac function tests which require patient cooperation may
be required to assess lung and heart function in some cases of severe
scoliosis, especially pre-operatively.
