An In Depth Review of Scoliosis: Idiopathic Scoliosis

Idiopathic scoliosis is considered in three age groups: Infantile--from birth to three years of age, juvenile--from greater than three years of age through nine years of age and, adolescent from 10-18 years of age. The adolescent type is the most common and represents about 80% of this type of scoliosis. In addition to the amount of spinal deformity, the patient's physiological age is assessed, i.e., is growth completed or is there more potential spinal growth (Fig.12).

Figure 12 Adolescent idiopathic scoliosis with
significant progression over two years

In the latter case, potential curve progression is related to the time remaining until maturity. Curve progression is often associated with degenerative intervertebral disc disease and degenerative joint disease of the spine in middle-aged or older patients or may be due to significant previously present undiagnosed or untreated scoliosis.

Idiopathic scoliosis treatment is patient-age dependent. In patients with infantile scoliosis (0-3 years) left-sided curves are commonly seen, particularly in boys and may resolve spontaneously with growth (Fig.13).

Observation treatment is done with repeat evaluation every four to six months. Use of orthoses (braces) and surgery is uncommon. Juvenile idiopathic scoliosis (3-9 year olds) may rapidly progress especially in children over the age of five and may require orthotic (brace) management (Fig.14).

Figure 14 7yr old boy with
juvenile idiopathic scoliosis

Surgery is indicated if the curve is unable to be controlled by orthotic means. Although surgery in a significantly skeletally immature spine will produce some decrease in ultimate spine height, it is better to have a shorter spine with more normal alignment than a progressive curve where height is lost because of deformity.

The most common of all types of scoliosis is adolescent idiopathic and is seen with equal frequency in boys and girls at low curve magnitudes. Girls, for unknown reasons, have a significantly higher risk for development of curve progression than boys. Pulmonary and cardiac function are not impeded with lumbar curves and significant changes of pulmonary function are not seen in patients with thoracic curves until the curve reaches a level greater than 70° , i.e., a severe curve. This amount of curve and subsequent cardiac and pulmonary changes are often seen later in life in untreated idiopathic infantile and juvenile scoliosis patients and present a threat to life. Patients with adolescent onset idiopathic scoliosis do not usually have such compromise unless severe curves develop. The time of highest risk for curve progression in adolescent idiopathic scoliosis occurs around puberty, i.e., when the growth rate is the fastest. Pulmonary and cardiac function tests which require patient cooperation may be required to assess lung and heart function in some cases of severe scoliosis, especially pre-operatively.