Infantile idiopathic scoliosis presents before the age of 3 years and is classified into two types – resolving and progressive.
Curves in patients with the resolving type tend to reduce spontaneously over time, whereas curves in patients with the progressive type continue to worsen leading to crippling deformity and reduced quality of life if not treated. There are x-ray markers that can be used to differentiate between the two types.
However, the difficult aspect for clinicians dealing with patients with idiopathic infantile scoliosis is that the two types can present identically in the initial stages. Observation is recommended as the initial action, however this can be challenging for parents and clinicians as they wait for a worsening in the patient’s deformity, which, may already be quite significant.
For patients with the progressive type of infantile scoliosis, the standard treatment involves placing the infant in a straightened position then applying a plaster cast. As the child grows, the casts are removed and replaced. This process is repeated, for years in some cases, until the scoliosis has been reduced. The casting process involves intubating and placing the infant under a general anaesthetic.
A surgeon, anaesthetist, nursing staff and a specialist table are required for the procedure, which takes approximately 90 minutes. While casting is successful in the management of most cases of infantile idiopathic scoliosis, there are concerns that the frequent exposure to anaesthetising agents may be damaging to the developing brain of the infant. Treatments such as bracing may represent a safer alternative, but further research is required in this area.