Juvenile Scoliosis
Juvenile Scoliosis
Juvenile idiopathic scoliosis is classically defined as scoliosis that is first diagnosed between the ages of 4 and 10. This category comprises about 10% to 15% of all idiopathic scoliosis in children. At the younger end of the spectrum, boys are affected slightly more than girls and the curve is often left-sided. Towards the upper end of the age spectrum, the condition is more like adolescent idiopathic scoliosis, with a predominance of girls and right-sided curves.
Evaluation
Just as described for infantile scoliosis, your pediatric spine surgeon may choose to order an MRI. This decision is based on the presentation of the curve, findings on physical examination, and radiographic features. As a rule of thumb, approximately 20% of children who are younger than 10 and who have a curve greater than 20º will have an underlying spinal condition. There is a particularly high incidence of Arnold-Chiari malformation (in which the brainstem is lower than normal) and syringomyelia (cyst in the spinal cord) associated with juvenile scoliosis, which might be detected on an MRI of the entire spine. (Figure 1) If something is seen on the MRI that could be causing your child's scoliosis, your doctor will probably refer you to a pediatric neurosurgeon. On occasion, a neurosurgical intervention may help correct the curvature.
Figure 1. Side-view MRI showing syrinx (cyst) in a 7-year-old boy with a 30° scoliosis.
Prognosis
Juvenile curves that reach 30° tend to continue to worsen without treatment. Bracing is often used to manage these curves, but nearly 95% of children in the juvenile age range go on to require surgical treatment.