What is Infantile and Juvenile Scoliosis?

Early-onset scoliosis (EOS) is a condition that happens in young children and it comes with its own special set of treatment steps. In general terms, scoliosis that shows up before the age of 10 is more complicated and difficult to deal with than scoliosis in a teenager. This is because the child’s spine and chest are still growing, but it’s also very crucial to keep a close eye on the development of their lungs.

What Causes Infantile and Juvenile Scoliosis?

Early-onset scoliosis is a condition that happens when a child’s spine curves before they turn 10 years old. There are several different causes of this condition. One cause is congenital scoliosis, which means the child was born with a curved spine. Another is structural scoliosis, which is when the shape of the spine changes. There’s also neuromuscular scoliosis, which happens when the nerves and muscles can’t maintain a straight spine. Syndromic scoliosis is linked to certain syndromes, while idiopathic scoliosis has no known cause.

The term infantile scoliosis is used to describe children with a curved spine who are younger than 3 years old when they’re diagnosed. Juvenile scoliosis refers to children between the ages of 3 to 10 who have a curved spine.

Risk Factors and Frequency for Infantile and Juvenile Scoliosis

Early-onset scoliosis, regardless of the cause, makes up about 10% of all childhood scoliosis cases.

Signs and Symptoms of Infantile and Juvenile Scoliosis

Patients may come in with a noticeable bend or twist to their spine, even if they don’t know they have a certain disease that can cause this. Sometimes, the first sign of such a disease can be this spinal issue. It’s important for the doctor to know your child’s complete health history, including details about their birth. During the physical exam, there will be a detailed examination of their nervous system, as well as the use of photographs to document the misshapes of the spine. Tests may also be done on the examination table (if possible) to assess how flexible their spine is or how stiff it has become.

Testing for Infantile and Juvenile Scoliosis

It’s essential for a complete check-up of a patient’s overall health status and social situation to be carried out by healthcare professionals as a team. Such an in-depth evaluation is crucial to ensure the best possible care and treatment.

When dealing with conditions related to the spine, imaging methods, like X-rays, are often used by doctors. X-rays primarily help doctors to track any changes in the structure of the spine and measure any bending or curving of the spine that isn’t normal.

In cases of a condition called early-onset scoliosis, which is a curve in the spine that develops in children, specific imaging methods are used. This technique helps doctors to understand the three-dimensional nature of the curve in the spine. The images are taken while the child is standing up or in an upright position, and very minimal radiation is used to get these images.

A Computed Tomography (CT) scan might be used as well. While this method uses more radiation, it provides very detailed images of the bony structure of the spine and ribs, helping doctors to understand the specifics of the condition better.

Another imaging tool that doctors might use is the Magnetic Resonance Imaging (MRI). This technology uses magnets to create images of the body’s internal structures. With MRI, doctors can identify any abnormalities in the spinal cord. It can spot common conditions that may accompany spinal issues like Chiari (a condition where brain tissue extends into the spinal canal), a syrinx (a fluid-filled cavity within the spinal cord), or a tethered cord (when the spinal cord is attached to the spine).

Treatment Options for Infantile and Juvenile Scoliosis

The main goal of treating and managing spinal deformities is to prevent the condition from getting worse. By doing this, the hope is to increase the size of the chest area to enhance the function of the lungs and heart.

Wearing a brace to support the spine is not usually effective and is also not well-received for people suffering from this condition.

Before moving forward with any form of treatment, it’s crucial that the patient’s overall health and ability to function is at its best.

Surgery is an option for some patients. Conventional growing rods can be inserted into the spine to serve as anchors. These rods can be made longer through periodic smaller surgeries. This approach can effectively manage the condition, but there are risks like infection, the rods coming loose, and the repeated necessity for surgery.

Innovative magnetic growing rods are another solution. The anchors are inserted as above, but the rod can be lengthened using a magnetic process. This treatment is suitable for patients who are at least 2 years old and weigh a minimum of 25 pounds. However, it’s important to consider that magnetic rods could impact future MRI scans.

For patients suffering from a condition where the chest cannot support normal breathing or lung growth, a surgical method using a vertical, expandable, artificial, titanium rib-expansion can help. This technique involves attaching devices to the ribs and the spine to increase the size of the chest and correct the spinal deformity.

Another surgical procedure called the Shilla procedure uses growth-guided techniques. A screw is placed into the rigid apical vertebrae (the area with the most severe curvature) as well as additional screws into other areas of the spine. The placement allows for the movement of the rod, guiding the alignment as the rod grows. The pressure on the rod typically leads to breaking after approx 4 to 6 years, usually when 4.5 mm rods are used.

There are also new techniques and technologies currently being tested and evaluated for treating spinal deformities.

These are some of the medical conditions that can present with similar symptoms:

Ankylosing Spondylitis
Aneurysmal Bone Cyst
Hemangioma
Juvenile Idiopathic Arthritis
Osteoid Osteoma
Osteoblastoma

What to expect with Infantile and Juvenile Scoliosis

Early-onset scoliosis is a group of diverse conditions affecting the curves of your spine. The condition’s outcome is mainly associated with other health problems and the state of the spinal deformity when it’s first observed. This can be connected to the symptoms, but more importantly, due to the effect the scoliosis has on the development and function of your chest.

Lung development is extremely important within the first 2 years of your life. By 8 years old, the maturity of the tiny air sacs in your lungs (alveoli) plateau. If scoliosis alters the function of your chest, it can lead to the underdevelopment of the alveoli, abnormal breathing, and reduced flexibility of the lung. It can also contribute to heart problems such as cor pulmonale (right ventricle heart enlargement) and high blood pressure in the lungs.

The ability of the chest to support healthy lung growth and functioning is known as thoracic insufficiency syndrome. If scoliosis negatively affects this, it could lead to complications.

The outcome of the spinal deformity heavily depends on the bone maturity of the patient and the level of the deformity. Growth of the spine from the chest to the lower back is typically 2 cm yearly for the first 5 years and then 1 cm yearly from ages 5 to 10, with a growth of 1.8 cm yearly until maturity. Rapid growth is seen in the first 5 years of life and during the teenage years.

The angle between the ribs and the spine at the most curved part of the spine (rib-vertebral angle or RVAD) provides insight into the progression of early-onset scoliosis under unclear conditions. A RVAD of more than 20 degrees at the first observation is likely to get worse.

Possible Complications When Diagnosed with Infantile and Juvenile Scoliosis

People who haven’t treated their early-onset scoliosis when they reach the age of 40 face a 50% higher chance of death. Also, people who have a spinal curve that’s larger than 70 degrees have shown a similar increased risk of death.