Introduction:
Scoliosis is a disorder affecting the spinal cord in which the spine develops a side-to-side curvature. In a normal person, the spine appears like a straight line below the neck, located along the middle of the back. A person having scoliosis will have his spine bent sideways and appear like a curve. It is an abnormality of the spine and should not be considered a poor posture. When scoliosis appears below three years of age, it is known as infantile scoliosis. A type of scoliosis that is present from the time of birth due to the irregular development of the spine while the baby is still in the mother’s womb is known as congenital scoliosis. Scoliosis between the ages of three and eight is called juvenile scoliosis.
What Is Infantile Scoliosis?
Infantile scoliosis is the left or right curvature of the spine in children below three years of age. It mostly occurs between the shoulder blades (a pair of large bones present on either side of the upper back) or the upper region of the spine. The spine may also be rotated or twisted, which pulls the ribs (series of slim and curved bones attached to the spine in pairs) to form a curved shape. The curvature makes the spine look like the letter “S” or “C.” Generally, it is seen that the spine tends to curve left more than right. In most children with infantile scoliosis, abnormalities are not present at the time of birth. It begins to develop around six months after birth. Researchers suggest that this disorder is more commonly seen in boys than girls.
What Are the Causes of Infantile Scoliosis?
The exact factor responsible for this condition is unknown. However, researchers have found a few possibilities which can cause this disorder. They are as follows:
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Intrauterine Molding: The spine gets affected during fetal growth due to the unusual pressure created by the uterus walls on a single side of the fetus. It can also be due to the abnormal position of the fetus inside the uterus.
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Postnatal External Pressure: This is due to the pressure applied to the spine after the child's birth. It is believed to happen when the baby is made to lie down on the back for long periods in the crib (child’s bed).
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Genetic Inheritance: Researchers believe that there is a higher occurrence of this condition in certain families due to some genetic components. However, the exact gene responsible for this has not been found.
What Are the Symptoms of Infantile Scoliosis?
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The head is not positioned at the exact center with the rest of the body.
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Uneven waistline.
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One leg looks longer than the other.
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Shoulders are uneven and tilted, with one shoulder protruding from the other.
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No uniformity in the arms positioned along the sides of the body while standing straight.
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The overall appearance of being bent to one side while standing.
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Prominence or a hump is seen on one side of the ribs.
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While bending forward, a difference is seen in the height between the sides of the back.
How Is Infantile Scoliosis Diagnosed?
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Physical Examination: Infantile scoliosis is usually detected in the first six months after birth during a general physical examination by a pediatrician. A detailed medical history from the child’s parent and a visual examination of the spine curvature is made. It is otherwise noticed by the child’s parents and is informed to the doctor. The main feature seen on physical examination is the curvature of the spine present either between the shoulders or between the uppermost and middle portion of the back. The curvature of the spine appears mostly towards the left.
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X-Rays: X-rays are considered to be one of the vital tools for diagnosing infantile scoliosis. It shows the exact angle of spine curvature in a two-dimensional way.
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EOS Imaging: This is done if any unusual finding is seen in the X-ray. It is a technique that makes use of a very low amount of radiation to create a three-dimensional image from a two-planar image. The child is made to stand before taking the images.
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Magnetic Resonance Imaging (MRI): A spinal MRI is taken. It is performed by combining a computer and large magnets to produce complete images of structures within the body. This method does not expose the child to radiation. It can rule out the possibility of any birth defects in the child.
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Computed Tomography (CT) Scan: CT scan uses X-rays and computer technology to create clearer images. It is useful in finding out the underlying cause of infantile scoliosis and rib cage problems.
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Radioisotope Bone Scan and Dual Energy X-ray Absorptiometry (DEXA) Scan: This helps to find out the strength and condition of the spine. The doctor may compare the child’s scan with the data obtained from normal children who do not show any abnormalities.
What Are the Treatment Options for Infantile Scoliosis?
The treatment for infantile scoliosis is decided based on the severity of the curvature of the spine.
In children with mild scoliosis (spine curvature less than 30 degrees), surgery is not needed. Regular monitoring (X-rays and lab tests) should be done to make sure that the curve does not progress. In mild cases, the curve usually does not increase and gets corrected automatically as the child grows.
Bracing And Casting: This is done if the spinal curve is between 30 and 50 degrees or if the curve progresses with time. The treatment may include the following:
- Bracing: This holds the spine in a partially corrected position and helps to prevent the further progression of the curvature. It is composed of hard plastic and should be worn for 22 to 23 hours per day. The striking benefit is that it can be put on or removed as needed at home. If the severity of scoliosis increases, casting may be advised.
- Casting: This procedure is done under general anesthesia. The spine is corrected to a straight position, and a custom-made cast is placed around the body (from shoulder to hip). It is repeated every few months and lasts for one to three years. It is the most effective way of correcting spine curvature when started early (before the age of 18 months).
Surgical Methods: This is done in severe cases when the curvature is more than 50 degrees. The following methods are used:
- Growing Rods: These are temporary rods that are attached to the child’s spine above and below the curve. The length of the rod is increased every six months to provide space for the spine to grow. The lengthening is done through a small incision (cut) at the back. This method decreases spinal deformity and increases spinal growth.
- Magnetic Expansion Control System (MAGEC): It is an improved version of growing rods with magnetic technology, which eliminates the need for repeated incisions. After an initial surgical procedure to attach the MAGEC system to the spine, the surgeon can increase the length of the rods using an external controller that signals the device to expand.
- Vertical Expandable Titanium Ribs (VEPTR): This is done in cases where spinal curvature affects the rib and lung development. VEPTR is an expandable titanium rib that expands the chest wall. It allows the child’s ribs and lungs to expand and grow. It also stabilizes the curved spine and is surgically adjusted until the child completes skeletal growth.
- Spinal Fusion Surgery: The abnormally curved spinal bones are realigned and joined together in spinal fusion surgery. Metal implants are inserted to correct the curve. This is done in children after treatment with growing rods or VEPTR and has finished growing. This is also done in previously untreated cases of severe spinal curvature. This surgery permanently stabilizes the child’s spine.
Conclusion:
The treatment for infantile scoliosis is very effective. The majority of children grow up without any limitations in the functioning of their daily activities and lead a normal life. Hence, providing the right treatment at an early stage helps the child to lead a healthy life.
