INFANTILE AND JUVENILE SCOLIOSIS

Matthew B Dobbs; Stuart L Weinstein

doi:10.1016/S0030-5898(05)70090-0

Scoliosis is a descriptive term that refers to a lateral curvature of the spine. The scoliosis may be structural or nonstructural. A structural scoliosis is a fixed lateral curvature with rotation. A nonstructural scoliosis corrects on side-bending radiographs or traction films. The most common structural curvature has no known cause and is referred to as idiopathic scoliosis. Traditionally, idiopathic scoliosis has been categorized based on age when the scoliosis was first identified; this is not necessarily the same as the time the curve first appears. Infantile idiopathic scoliosis is defined by the age at onset of younger than 3 years. Juvenile idiopathic scoliosis is defined as idiopathic scoliosis detected between ages 3 to 10 years. Adolescent idiopathic scoliosis is detected between age 10 years and skeletal maturity. 20 These three ages were theoretically supposed to coincide with periods of increased growth of the spine. Although growth velocity does increase during infancy and adolescence, it is steady during the juvenile period. 3 Because scoliosis curve progression is maximal during the peak periods of growth, Dickson et al 12 believed juvenile-onset scoliosis was rare enough not to warrant a separate category. He, therefore, proposed that idiopathic scoliosis should be divided into two subgroups: early onset (0 to 5 years old) and late onset (>5 years old). Pedriolle and Vidal 45 retained the traditional classification but stated that the age ranges do not refer to the age of the patient at the time of onset of the scoliosis or at diagnosis but instead refer to the age at onset of the main period of progression. This article uses the traditional chronologic definition of infantile and juvenile scoliosis because there are many important differences in natural history between these subtypes. From a cardiopulmonary viewpoint, however, it makes more sense to distinguish between early onset (<5 years old) and late onset (>5 years old). 12 Dickson's division of infantile idiopathic scoliosis into early onset and late onset is supported by the observation that many life-threatening cardiopulmonary abnormalities are associated with scoliosis in children who develop large curves before 5 years of age. 4,46,55 This age correlates with the postnatal phase of pulmonary development—a phase characterized by a significant increase in functional alveoli. 4 Therefore, the early-onset group is most at risk for development of restrictive pulmonary disease, pulmonary artery hypertension, and cor pulmonale. 46 Meanwhile, in a long-term study of adolescent idiopathic scoliosis, pulmonary function was clearly shown to remain normal even if curve magnitude exceeded 100°. 47,59

INFANTILE AND JUVENILE SCOLIOSIS

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