INFANTILE AND JUVENILE SCOLIOSIS

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Scoliosis is a descriptive term that refers to a lateral curvature of the spine. The scoliosis may be structural or nonstructural. A structural scoliosis is a fixed lateral curvature with rotation. A nonstructural scoliosis corrects on side-bending radiographs or traction films. The most common structural curvature has no known cause and is referred to as idiopathic scoliosis.

Traditionally, idiopathic scoliosis has been categorized based on age when the scoliosis was first identified; this is not necessarily the same as the time the curve first appears. Infantile idiopathic scoliosis is defined by the age at onset of younger than 3 years. Juvenile idiopathic scoliosis is defined as idiopathic scoliosis detected between ages 3 to 10 years. Adolescent idiopathic scoliosis is detected between age 10 years and skeletal maturity.20 These three ages were theoretically supposed to coincide with periods of increased growth of the spine. Although growth velocity does increase during infancy and adolescence, it is steady during the juvenile period.3 Because scoliosis curve progression is maximal during the peak periods of growth, Dickson et al12 believed juvenile-onset scoliosis was rare enough not to warrant a separate category. He, therefore, proposed that idiopathic scoliosis should be divided into two subgroups: early onset (0 to 5 years old) and late onset (>5 years old). Pedriolle and Vidal45 retained the traditional classification but stated that the age ranges do not refer to the age of the patient at the time of onset of the scoliosis or at diagnosis but instead refer to the age at onset of the main period of progression.

This article uses the traditional chronologic definition of infantile and juvenile scoliosis because there are many important differences in natural history between these subtypes. From a cardiopulmonary viewpoint, however, it makes more sense to distinguish between early onset (<5 years old) and late onset (>5 years old).12

Dickson's division of infantile idiopathic scoliosis into early onset and late onset is supported by the observation that many life-threatening cardiopulmonary abnormalities are associated with scoliosis in children who develop large curves before 5 years of age.4, 46, 55 This age correlates with the postnatal phase of pulmonary development—a phase characterized by a significant increase in functional alveoli.4 Therefore, the early-onset group is most at risk for development of restrictive pulmonary disease, pulmonary artery hypertension, and cor pulmonale.46 Meanwhile, in a long-term study of adolescent idiopathic scoliosis, pulmonary function was clearly shown to remain normal even if curve magnitude exceeded 100°.47, 59

Section snippets

Natural History and Epidemiology

Infantile idiopathic scoliosis is a structural spinal deformity detected during the first 3 years of life. It is slightly more common in Europe and accounts for fewer than 1% of all cases of idiopathic scoliosis in the United States.21 The prompt recognition of infantile scoliosis is critical and is the responsibility of parents and pediatricians. Early orthopedic referral is mandatory because early treatment can affect the outcome.40

Infantile scoliosis is unique in many ways. It is more

Natural History and Epidemiology

Juvenile idiopathic scoliosis is defined by detection of the scoliosis deformity in patients between 4 and 10 years of age; it represents 12% to 21% of patients with idiopathic scoliosis.48 The cause remains unknown and may differ depending on age of presentation. Because juvenile and adolescent scoliosis appear to be more closely related to each other than to infantile scoliosis, theories regarding the cause of adolescent scoliosis also may be applicable to juvenile scoliosis. There are a

SURGICAL TREATMENT OPTIONS FOR BOTH INFANTILE AND JUVENILE SCOLIOSIS

The type of surgery performed depends on the age of the child at the time the curve is progressing. The amount of spinal growth remaining is the chief consideration. It has been shown that curve progression and increased curve rotation occur with posterior fusion alone.17, 39, 54 In young patients after a posterior fusion, anterior spinal growth continues, which causes an increase in vertebral body height. In addition, the vertebral bodies rotate on the posterior fusion, causing an increase in

SUMMARY

The diagnosis and treatment of scoliosis in the growing child is a challenging endeavor. It is crucial that the correct diagnosis be established initially. Early referral and treatment is imperative. Careful follow-up is mandatory. If a deformity is proved to be progressive despite bracing, surgical intervention is likely to be necessary. Because significant truncal shortening is an issue with early spinal fusion, a young child may benefit from instrumentation without fusion. Ultimately,

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    Address reprint requests to Stuart L. Weinstein, MD, Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242

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    Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa

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