Infantile Scoliosis

Infantile scoliosis is classically defined as scoliosis that is first diagnosed in a child between birth and 3 years old. Congenital spinal anomalies (i.e., misshapen and connected vertebrae) are also often diagnosed during this period, but are not included in the infantile category. Many infantile curves will resolve without treatment. Those that do not resolve can be very difficult to manage. Your pediatric spine surgeon may suggest a magnetic resonance imaging (MRI) study in a case of unresolving infantile idiopathic scoliosis to determine if there are any abnormalities of the spinal cord or spinal column that are causing to the deformity. The decision to get an MRI in an infant is not a simple one. Generally sedation, or even anesthesia, with their associated risks, is necessary to relax the child so that good images can be taken. Most infantile idiopathic scoliosis curves are left sided curves in the thoracic (chest) area. It is more common in boys than girls. In some patients, there is an increased association with hip dysplasia, mental retardation, and congenital heart disease. Many other infants are healthy and normal and simply have a small curvature of the spine.

Treatment

When scoliosis occurs at a very young age, there are several important implications for management and treatment. For example, a 60° idiopathic (cause of scoliosis unknown) curve in a teenager is typically managed quite successfully with a posteriorly instrumented spinal fusion. If the same 60° curve in a 2 year old is managed with a posteriorly instrumented spinal fusion, the anterior spine would continue to grow while the posterior spine is fused. This would likely lead to the "crankshaft phenomenon" with a progressive increase in the spine deformity and shortening of the trunk. The fusion would also tend to limit the amount of chest wall and lung growth that could be expected. For this reason, other techniques have been developed for management of early onset scoliosis. These techniques take into account the growth of the spine as well as the growth of the rib cage and the lungs. Most techniques currently used require multiple expansions or lengthenings of any implants that are placed in a very young child. This surgery is required once or twice per year to keep up with the growth of the young spine.