Idiopathic Scoliosis

What You Should Know About Idiopathic Scoliosis

Idiopathic scoliosis develops in childhood and is categorized based on the age of onset of the scoliosis. It is generally categorized into Early Onset Idiopathic Scoliosis (EOS), and Late Onset Idiopathic Scoliosis (LIS). Early onset scoliosis consists of infantile scoliosis (age birth to 3 or 4 years), and Juvenile scoliosis (4 to 9 years). Late onset scoliosis is also termed adolescent idiopathic scoliosis. Adolescent scoliosis typically has its onset in ages 10 to 18 years. In children, the period of rapid growth occurs from the time of birth to the age of three or four, and again during adolescence. Scoliosis progression mirrors this growth pattern, with rapid curve progression in infancy (0-3 years of age), followed by slower progression during the juvenile period (4-9 years of age), and another rapid phase of progression in adolescence (10-18 years of age). The earlier the age of onset of scoliosis, the more disabling it can become.

Infantile Scoliosis develops between birth and 3 years of age. Many of the curves in this age group resolve over time with bracing. However, those that persist can rapidly progress and be difficult to manage. Scoliosis in this age group can also be caused by congenital defects of the spine, called congenital scoliosis. The defects are malformed or partially formed vertebral bodies that can cause the spine to grow unevenly and result in scoliosis. Progressive scoliosis in this age group can cause significant lung problems due to lack of normal lung development.

Juvenile Scoliosis develops in the age group of 4 to 9 years. Some of the curves in this age group may also resolve with bracing treatment. But, patients with this type of scoliosis can also have rapid progression that leads to severe scoliosis. Congenital defects can also cause scoliosis in this age group. This group of patients is treated similarly as those in the infantile group. An MRI may be recommended to evaluate for congenital defects of the spine and spinal cord. Progressive scoliosis in this age group can also cause significant lung problems due to lack of normal lung development.

Adolescent Scoliosis (10 to 18 years): This type of scoliosis develops during the pre-teen and teenage years. It is more common in females. It typically becomes apparent during the adolescent growth spurt. Unlike infantile and Juvenile idiopathic scoliosis, the lungs are usually developed by this age and lung problems are not as severe unless the scoliosis is of a higher magnitude (80 degrees). The most common type affects the thoracic spine (upper spine, rib cage).

Symptoms

Idiopathic scoliosis is usually non-painful. It is frequently first detected by parents or pediatricians who notice asymmetry of the spine. A prominence or hump may develop in the area of the spine affected and be the first sign or symptom of scoliosis. 

Diagnosis

School nurses, pediatricians and parents often first detect scoliosis. Scoliosis is familial, meaning it does run in families, and parents with a history of scoliosis should have their children screened for scoliosis. The Adam's bending test is used to detect asymmetry of the spine. This is performed by having a child place her hands together and bending at the waist while reaching for the floor. If scoliosis is present, a prominence on one side of the spine will be present. If there is suspicion for scoliosis, x-rays will be performed to evaluate it. An MRI may also be used to evaluate the spinal cord and vertebral bodies to detect any congenital defects that may be present. Congenital defect are more common in the early onset type of scoliosis with onset in the years from birth to 9 years of age. X-rays of the hand may also be taken to determine the amount of growth a child may have remaining. This allows the physician to better predict the chances of the scoliosis progressing.

Treatment

Early Onset Idiopathic Scoliosis ( onset birth to age 9)
Treatment recommendations are determined by the age of the patient and the severity of the scoliosis. In general, the younger the patient, the greater the chance of scoliosis progression. Observation may be the initial form of treatment if the curve is small.

Adolescent Idiopathic Scoliosis
Treatment recommendations are dependent on the size of the curve and the age of the child. Scoliosis progresses with growth. The greater the magnitude of the scoliosis, and the younger the child, the more chance for curve progression. If a child is 10 and appears to have a large amount of growth left, then treatment will be instituted. Bracing is usually recommended for curves in the 25 to 35 degree range. Surgical treatment may be recommended if the curve reaches 50 degrees in a growing child. This recommendation is based on the knowledge that curves in this range have a greater chance of progression and may continue to progress into adulthood. The treatment is typically rod placement and fusion. The rods help reduce the size of the curve and prevent it from progressing while the body fuses (welds or knits) the vertebral bodies together into one piece. This occurs through a process much similar to the way a broken bone heals. Most patients are able to return to normal activities by one year following surgery.