Idiopathic Scoliosis – Juvenile

is classically defined as scoliosis that is first diagnosed between the ages of 4 and 10. This category comprises about 10% to 15% of all idiopathic scoliosis in children. At the younger end of the spectrum, boys are affected slightly more than girls and the curve is often left-sided. Towards the upper end of the age spectrum, the condition is more like adolescent idiopathic scoliosis, with a predominance of girls and right-sided curves.

Evaluation

Just as described for infantile scoliosis, your pediatric spine surgeon may choose to order an MRI. This decision is based on the presentation of the curve, findings on physical examination, and radiographic features. As a rule of thumb, approximately 20% of children who are younger than 10 and who have a curve greater than 20 will have an underlying spinal condition. There is a particularly high incidence of Arnold-Chiari malformation (in which the brainstem is lower than normal) and syringomyelia (cyst in the spinal cord) associated with curves under 10, which might be detected on an MRI of the entire spine. If something is seen on the MRI that could be causing your child’s scoliosis, your doctor will probably refer you to a pediatric neurosurgeon and the condition will be reclassified as a neuromuscular scoliosis. On occasion, a
eurosurgical intervention may help correct the neuromuscular curvature.

Prognosis

Juvenile curves that reach 30 degrees tend to continue to worsen without treatment. Bracing is often used to manage these curves, but nearly 95% of children in the juvenile age range go on to require surgical treatment.

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. Some children will have a curvature of their spine that is stable and unchanging, whereas other children will have a curve that relentlessly progresses. 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 pediatric spine surgeon will probably want to see your child every 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. 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. 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.