What are the other Names for this Condition? (Also known as/Synonyms)

• Curved Spine due to Juvenile Scoliosis
• Early-Onset Adolescent Idiopathic Scoliosis
• Juvenile Idiopathic Scoliosis

What is Juvenile Scoliosis? (Definition/Background Information)

• Scoliosis is a spinal deformity that is characterized by a sideways curvature of the spine in which, the spine or the backbone, bends or curves sideways to look like an “S” or “C”, instead of an “I”
• Juvenile Scoliosis is another form of idiopathic scoliosis that affects children between the age of 3 and 9 years. it is characterized by an abnormal lateral curvature of the spine, usually greater than 10 degree deviation, which causes the spinal column to bend to the right or left in the shape of an “S” or “C”. It mostly appears as a right thoracic curve
• Juvenile Scoliosis generally develops during a period in which the spine does not undergo significant growth. It accounts for 10-15% of all idiopathic scoliosis cases in children
• Children affected by Juvenile Scoliosis mostly tend to have a right curve, but it should be noted that left curves generally tend to have a better prognosis. There is no pain felt, only a certain amount of discomfort and stiffness that is experienced by the children
• The progression rate is very high and reports are available to show that in about 70% of the affected children, the condition worsens at a fast rate. Such cases definitely require active treatment
• Juvenile Scoliosis cannot resolve on its own. Bracing and surgical intervention methods are the commonly used treatment methods in the management of the condition
• Juvenile Scoliosis is an idiopathic disorder meaning that the exact cause of the condition is not known. However, various hypotheses have been evolved with regards the cause of origin of Juvenile Scoliosis

Who gets Juvenile Scoliosis? (Age and Sex Distribution)

• Juvenile Scoliosis is a form of idiopathic scoliosis that affects children, who are between the ages of 3 and 9 years
• When children between 3 and 6 years are affected, an equal incidence among both the gender is seen. When children between 6 to 10 years are affected, the incidence is seen more in the female gender than the male gender
• No ethnic, racial, and geographical predominance is observed

What are the Risk Factors for Juvenile Scoliosis? (Predisposing Factors)

The risk factors associated with Juvenile Scoliosis include:

• Age: Young children between the ages of 3 and 9 years are most vulnerable
• Genetic inheritance: This disorder is caused due to genetic inheritance. However, the exact genes associated with the incidence of Juvenile Scoliosis are yet to be identified

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Juvenile Scoliosis? (Etiology)

The underlying cause of Juvenile Scoliosis is unknown. However, various hypotheses have been proposed with regards the cause of Juvenile Scoliosis occurrence and these include:

The first theory states that:

• Deficits in proprioception seems to be one of the cause for Juvenile Scoliosis
• Children generally do not realize when they are not positioning themselves upright
• The spine bends to one side to compensate for the deficit
• The bend maintains itself, as the ligament surrounding the vertical joints may get stretched and tightened, in accordance with the position that is most often maintained
• The spine rotates itself on its axis causing the ribs on one side of the chest to rotate as well

The second theory relates to genetic inheritance:

• Juvenile Scoliosis is seen occurring in many members of the same family
• The set of genes causing scoliosis may be inherited
• But the inheritance does not seem to occur in the usual dominant pattern, and hence, the exact genes associated with Juvenile Scoliosis are still not known definitely

Much about the causes for Juvenile Scoliosis remains to be discovered and fully understood. Research work is under process at various academic medical centers.

What are the Signs and Symptoms of Juvenile Scoliosis?

The symptoms and signs of Juvenile Scoliosis may include:

• Inequality in the length of the legs
• Midline skin defects such as hairy patches and dimples
• Signs of spinal dysraphism (congenital malformations of the spine and spinal cord)
• Differences in shoulder height
• Truncal malformations
• Deformity of the ribs such as one side of the rib protrudes and is more prominent than the other side
• Asymmetry of the waist
• Neurofibromatosis (a genetic disorder of the nervous system)
• Cavovarus or foot deformities
• Asymmetric abdominal reflexes

How is Juvenile Scoliosis Diagnosed?

The initial diagnosis of Juvenile Scoliosis is generally done by the parents or the caretaker of the child. They may notice the rib hump, uneven shoulders, and unevenness of the hips.

• The second step in the diagnosis process will involve a thorough physical examination of the patient by a health professional who might follow:
• Adams forward bending test:
  • Under this procedure, the child is asked to bend forward at the waist until the spine becomes parallel to the floor
  • The shape of the spine is observed, while the child is still in the bended position
  • The physical examiner will also observe the rib hump (a condition where the rib protrudes on one side when compared to the other side, when the child bends forward)    
  • Use of scoliometer, an instrument that is used to measure the extent of the ‘humping’   
  • Screening test of the whole upright posture is done to check the exact location of the scoliosis; whether it is in the upper part of the torso or in the lower back
  • Radiographs are taken to assess the severity of the curve
  • Treatment is based on the Cobb angle measurement
  • Neurological examination and magnetic resonance imaging (MRI) scans are conducted to confirm that scoliosis has not occurred due to neurological conditions and that the spinal cord is not affected by any other underlying medical conditions
  • X-rays are taken to give clear images of the bones and precise measurements of the curve

What are the possible Complications of Juvenile Scoliosis?

Complications that may be caused due to Juvenile Scoliosis could include:

• Crankshaft phenomenon: A complication that occurs when the front part of the spine keeps growing, when the back part is fused through surgery to correct the scoliosis defect

How is Juvenile Scoliosis Treated?

Juvenile Scoliosis does not resolve spontaneously on its own; the condition has to be appropriately treated. The treatment methods to be adopted will be based upon:

• Severity of the spinal curvature
• Age of the patient
• Likelihood of how much the curvature will worsen in the future.

Active treatment methods have to be adopted to correct the curve. The progression of the curve takes place at a fast pace, and hence, early diagnosis and immediate medical intervention is the need of the hour.

• Observation method: In small curves which measures less than 25 degrees, observation is the only treatment method suggested. However this method is very inaccurate and ineffective. Correction of the curve at the initial stage itself is not possible through this treatment method
• Physiotherapy:
  • It can be effectively used in curves which measures between 10 and 20 degrees
  • An intensive course of physiotherapy treatment can help correct and control the curve to a certain extent
• Spinecor bracing:
  • This is a treatment method used to correct curves measuring greater than 15 degrees and when a family history for scoliosis has been observed
  • It is a dynamic brace that helps retrain and strengthen the spine
  • This treatment method is especially useful in treating curves which measures greater than 45 degrees
• Hard bracing:
  • This treatment method is very effective in treating curves greater than 45 degrees
  • Use of Gomez TSLO brace is often recommended to control and correct the curve
  • Since the curves continue their progression when the bracing treatment is being done, surgical intervention is the best method of treatment that is recommended
  • The physician in certain cases may discontinue the bracing method for 1 or more years and return to observation method based on the severity of scoliosis and may reintroduce bracing method, as the child begin an adolescent growth spurt
• Serial casting:
  • When children are diagnosed with a spine which is fixed in an abnormal position that cannot be temporarily straightened, the use of serial casting is recommended
  • Under this method, a cast is applied that is changed every 6-12 weeks and is used in correcting the curvature
  • Casting treatment is followed up with bracing treatment method, which is required to maintain the correction.
• Surgery:
  • Special rods called “growing rods” are used to maintain correction
  • Under this method a rod is attached to the spine and is periodically lengthened by a simple procedure
  • Nearly 95% of the children suffering from Juvenile Scoliosis need surgical treatment.
• Spinal fusion:
  • When the curve is long and the child has attained reasonable maturity, a definitive spinal fusion is recommended
  • This method involves fixing rods to the spine to stop the progression and sometimes may also require a bone graft

How can Juvenile Scoliosis be Prevented?

Currently, there are no definitive methods available to prevent Juvenile Scoliosis.

What is the Prognosis of Juvenile Scoliosis? (Outcomes/Resolutions)

• The treatment methods for Juvenile Scoliosis have been proved to be extremely successful
• Children affected by scoliosis and who have undergone successful treatment, grow up without any limitations to their physical activities and daily functioning
• Despite some challenging hurdles faced by the affected children in early childhood, the child is expected to live a normal, healthy, and active life and grow into the adolescent and adulthood stage.
• Juvenile curves that reach 30 degrees will worsen without treatment

Additional and Relevant Useful Information for Juvenile Scoliosis:

• If any observation is made by the physical examiner during an MRI scan, which he/she suspects could lead to scoliosis, then the patient may be referred to a pediatric neurosurgeon and the condition will be classified as neuromuscular scoliosis
• There seems to be a high incidence of Arnold-Chiari malformation (a condition where the position of the brainstem is lower than normal), tethered cord, and syringomyelia (a cyst in the spinal cord), which are also associated with curves measuring over 10 degrees