Infantile scoliosis is an idiopathic scoliosis that affects children younger than 4 years of age. It usually begins to develop in the first 6 months of life. Like other types of scoliosis it is characterised by an abnormal sideways S or C curve of the spine.
Infantile scoliosis is most often seen in boys and accounts for less than 1% of idiopathic cases. The most common curve type is a left curve.
When a right curve is present, particularly in girls, this usually indicates a poorer prognosis. Sometimes these cases can resolve spontaneously, sometimes they can progress to a more severe scoliosis. Depending on the case, the treatment of infantile scoliosis may involve observation, physical therapy, bracing and as a last resort surgery.
How is Infantile Scoliosis diagnosed?
Infantile scoliosis is usually detected in the first 6 months of life during a routine examination by a pediatrician, nurse or noticed by a child’s parents. When scoliosis is suspected, a careful neurologic exam and MRI should always be carried out to insure that the scoliosis is not the result of a neurological condition and that the spinal cord is not being affected by another disease. Even with an MRI it is still normal for x-rays to be taken. Unlike MRI, x-rays give clear images of the bones and allow for more precise measurements of the curvature.
How is Infantile Scoliosis treated?
As many cases of infantile scoliosis resolve without intervention there are varying opinions on when treatments such as casting and bracing are needed. As a general rule, the larger the curve the more likely it is to progress. As a guide, curves between 10 and 20 degrees have a greater chance of resolving without treatment than do curves greater than 20 degrees. Hence intervention may be recommended when a curve is greater than 20 degrees. However all curves at some stage pass through the 10-20 degree range and there may be indications for early intervention in some cases.
In the small 10 to 20 degree curves, observation is usually recommended. This means that the child should be reviewed by a specialist who will monitor the progression of the curve with physical examination and x-rays. It is very important that these appointments are regular, as a curve can suddenly worsen with a small amount of growth. In cases where an infantile scoliosis resolves without intervention, the child should continue to be reviewed upto and throughout adolescence. This because growth throughout the years may trigger a return of the scoliosis or progression in a mild case, even in a previously non-progressive curve. If progression does occur in these patients casting and bracing treatment will usually be recommended.
In infants with curves greater than 20 degrees there is a greater chance of the curve progressing. As a result, casting and bracing treatment are often recommended to try and stop progression and make correction to the spine. Casting refers to a treatment known a serial casting, a process whereby a corrective plaster jacket is applied to try and reduce the curve. The cast is changed, usually every 6 to 12 weeks, in an attempt to gradually correct the curvature. The cast is made of plaster or fiberglass and is usually applied in the operating room under a general anaesthetic. This means that the infant will be asleep during the application process. Rigid brace treatment usually with a type of TLSO will usually follow casting treatment in an attempt to try and maintain the correction achieved via casting.
In some cases, where the curve is greater than 20 degrees but not yet severe, a rigid brace can be used instead of a cast. Other applications for rigid bracing are when the patient can not be anaesthetised or there are other complications that prohibit casting.
When bracing is used following casting or in its own right, the brace is worn full time except for bathing and during exercise. This regime is usually maintained for 2 to 3 years. After this time the child may be weaned off the brace or moved to part time use, provided the curve is stable. When the child is old enough, scoliosis specific exercise may play a role in helping to stabilise brace correction. In a minority of cases, casting and bracing do not stop the progression of the curve and surgery is the only option.
Surgery in infantile scoliosis is a last resort because of the complications of operating on a small and growing spine. Surgery may consist of the placement of rods which are attached to the spine to maintain curve correction. In some cases special rods called growing rods can be used in an attempt to maintain correction and allow growth.