Scoliosis is a deformity in the spine that causes an abnormal C-shaped (one curve) or S-shaped curvature (two curves). The spine is not straight but curves to one or both sides. There are three types of scoliosis depending on when it develops. Infantile occurs from birth to three years of age. Juvenile scoliosis develops between four and nine years of age. Adolescent presents between 10 years and when growth is complete.
In a recent study from an international spine study group, X-ray results after surgery were compared for children with idiopathic early-onset scoliosis (IEOS) and adolescent idiopathic scoliosis (AIS). Idiopathic means the cause of the spinal curve is unknown. This type of scoliosis can develop at any age and is therefore named according when it occurs.
For example, spinal curvatures that develop between the ages of birth and three years is referred to as infantile idiopathic scoliosis or IIS. Juvenile idiopathic scoliosis or JIS is first seen in children between the ages of four and nine. And scoliosis that develops between the ages of 10 and 18 is referred to as adolescent idiopathic scoliosis (AIS). The added term “early-onset” refers to children five years old and younger.
This study group called Growing Spine Study Group (GSSG) was started in an effort to improve treatment for early-onset scoliosis. Since that time, 22 Spine Centers in seven countries have joined forces to collect data on childhood and adolescent scoliosis. The group is made up of 36 specialized surgeons trained in the treatment of complex spinal deformities among the younger pediatric population (birth to age five).
Using the GSSG database of collected information, the authors reviewed the X-rays before and after spinal surgery for children diagnosed with idiopathic early-onset scoliosis (IEOS) and compared the results against a second (older) group. They used the records from another (separate) database (the Harms Study Group) for the second group of patients. The Harms Study Group collects data on children with adolescent idiopathic scoliosis (AIS).
In this way, they could identify differences in the characteristics of the spinal curvatures between these two age groups (birth to age five from the Growing Spine Study Group and 10 years to 18 years from the Harms Study Group). Various spinal angles, lines, curve directions and curve locations (thoracic spine, lumbar spine, thoracolumbar spine), and severity (magnitude) of spinal curves were measured and compared.
Their findings suggest that curves in younger children are present more often in the lower spine and may require a more distal (lower down) spinal fusion. There are some distinct disadvantages or drawbacks (as the authors refer to them) in doing spinal fusion surgery in the lower lumbar spine. For example, this type of fusion limits spinal flexibility and movement while concentrating stress on one area of the spine. These are important considerations when performing spinal surgery on the very young.
There is also evidence that in the idiopathic early-onset group, there is a larger degree of kyphosis (forward curve of the spine). And with a larger kyphosis, there is a greater chance for pull-out anchors used in the fusion surgery to pull out. This can create a less-than-stable result. Surgeons are careful to use proximal anchors in such cases.
Larger curves in the younger children may suggest a tendency to delay surgery in younger groups. This is the finding we thought most useful for you. But the question is usually asked: what’s best for the child in the long-term? Does postponing surgery except in the most severe spinal deformities create more problems later? We don’t know yet — these are questions that must be addressed in future studies.
Treatment approaches and surgical techniques with the best outcomes are the current focus of multicenter research studies. Information is published as studies come available to aid physicians in advising families what is best for each individual child. Some of this depends on the type of scoliosis, severity of the curve, age of the child, and any other medical conditions that may be present.