Infantile Scoliosis (Pediatric)

What is infantile scoliosis?

Infantile scoliosis is an idiopathic condition that affects children before the age of 3 and is characterized by the presence of an abnormal curve of the spine to the right or the left. This curvature causes the spinal column to bend to one side in the shape of an S or a C. The condition is seen more frequently in males than females. Those with the infantile form generally fall into two groups: those whose curvature disappears with growth and those whose curvature becomes progressive. Most cases resolve spontaneously but some may progress to more severe deformity. Treatment of infantile scoliosis may include observation, physical therapy, bracing, casting, and, under rare circumstances, surgery.

Some basic facts about infantile scoliosis are:

• Scoliosis is defined by the presence of a curve in the spine that's more than 10 degrees to the right or left.
• Most infants that develop abnormal curves do so in their first six months of life.
• Infantile scoliosis is a rare condition accounting for less than 1 percent of all cases of idiopathic scoliosis.
• The condition is more common in Europe than in the United States.
• For unknown reasons, the curve in the spine tends to bend to the left in infants with scoliosis. However, females who develop curves that bend to the right have a worse prognosis than other infants.
• For reasons not yet to be understood, children who develop scoliosis before the age of 5 are more likely to have cardiopulmonary abnormalities in infancy.
• Infants with idiopathic scoliosis usually do not experience any pain from the condition.

What causes infantile scoliosis?

The exact cause is unknown, however, robust medical research on infantile scoliosis has led to different theories of what causes the condition, as follows:

Evidence suggests intrauterine molding may be responsible for developing infantile scoliosis. With intrauterine molding, the spine is affected during fetal growth because of abnormal pressures exerted by the walls of the uterus on one side of the fetus’s body or abnormal positioning of the fetus within the uterus. Epidemiological data supports this theory and demonstrates there are higher rates of plagiocephaly (a slight flattening of one side of the head) and developmental dysplasia of the hip (a condition that affects one of the hips) on the same side as the spinal curve in infants with this scoliosis.

A second theory suggests that postnatal external pressures are exerted on the spine after birth, perhaps due to infants lying on their backs for extended periods of time in a crib.

Genetic inheritance may also cause infantile scoliosis. While the genes involved have yet to be identified, research shows there is a higher incidence of the condition within some families, lending considerable weight to this theory.

Despite notable evidence for these theories, much about the condition remains to be discovered and fully understood. As a result, there is ongoing research at a number of academic medical centers throughout the United States attempting to uncover the keys to the development of infantile scoliosis and improve treatment and prevention of the condition.

How is infantile scoliosis diagnosed?

A standard physical exam by a pediatrician usually detects infantile scoliosis within a child's first six months of life. When scoliosis is suspected, additional tests will be ordered, including a careful neurological exam, followed by an exam of the head, back, and extremities to inspect for plagiocephaly and ensure the spinal cord is not affected by another condition.

In addition, a spinal MRI is essential to confirm the findings of the neurological exam and rule out other causes of infantile scoliosis. A series of X-rays are also done to take a precise measurement of the curvature's severity.

What is the treatment for infantile scoliosis?

Treatment decisions for infantile scoliosis depend mostly on the severity of the spinal curvature and the likelihood that it will worsen in the future.

Children with mild curves (10-25 degrees) are treated only with observation as these curves rarely become more severe and usually correct themselves. Observation entails regular visits to an orthopaedic surgeon, who monitors the curve with physical exams and X-rays. Visits must continue into adolescence because growth spurts may trigger progression, even in a previously non-progressive curve.

Infants with moderate and severe curves have a greater chance of progression and often require casting and/or bracing treatment. Managing the demands of bracing or casting treatment is difficult for infants and their parents. Surgery at such a young age, if necessary, can also seem daunting. However, research shows such treatment for infantile scoliosis tends to be successful. The vast majority of children grow up without any limitations to their daily functioning and enjoy a range of activities from simple outdoor games to competitive sports. With the right treatment, children are expected to live normal, healthy lives.