Infantile Scoliosis
Observation

Observation is usually the first method of treatment for a young child with a spinal deformity. The physician will first need to determine if the curvature is progressing--that is, getting worse. Some children will have a curvature of their spine that is stable and unchanging, whereas other children will have a curve that relentlessly progresses. Just because the pediatric spine surgeon is "observing" your child does not mean that he/she is not treating them. During this period of time, not only will your child's doctor look for changes in the curve, but they will probably order some special tests to evaluate further the child's condition and have you see some other doctors. These tests may include an MRI study or a CT study. Your child may be referred to other specialists, such as a geneticist, cardiologist, or pulmonologist to make sure there are no other problems in other parts of the body.

An MRI study is often done to evaluate the spinal cord and find any abnormalities that may be causing the scoliosis or kyphosis(round back). In children, sedation is usually administered to relax the child during the hour it takes to complete the scan. Very young children may require general anesthesia, which is not without risk. No radiation is involved. A CT scan may be done to study better the anatomy of the deformity in congenital scoliosis (Figure 3). If your child is suspected of having thoracic insufficiency syndrome, then your spine surgeon may also order a CT scan of the chest to measure your child's lung volumes so they can be compared to normal values. Properly adjusted for children, CT scans involve a very low level of radiation exposure.

Figure 3. Three-dimension CT scan of the spine showing a hemivertebra (partially formed vertebra).

Your pediatric spine surgeon will probably want to see your child every four to six months and have new front- and side-view X-rays made. They will then measure the curves and compare them with the previously made films, as well as the films from the child's first visit. It is ideal to have all of the radiographs done at the pediatric spine surgeon's office so that he/she can have similar types of radiographs for comparison and maintain your child's record. The doctor will probably continue to observe your child's curves as long as there is no drastic increase in the size of the curve. In some rare cases, the curve improves or even resolves (as in infantile scoliosis). If your pediatric spine surgeon documents progression of the curve, though, a different form of treatment will need to be instituted. He/she will probably want to obtain bending radiographs of the spine to assess flexibility and help determine the next course of treatment.