Scoliosis is not simply a “curve” of the spine… it is a more complex, three-dimensional deformity that can be diagnosed in childhood. Progressive infantile scoliosis is a serious condition that can become life-threatening if not treated properly. The abnormal twisting of the spine can cause abnormal thorax growth which is accompanied by decreased lung volumes in severe cases. There are also multiple visible issues including uneven shoulders/hips, spinal misalignment, forward neck bending, cosmetic deformities of the back and chest wall, and psychological distress.
Scoliosis in children is typically classified into three categories:
- Congenital scoliosis indicates structural issues of the spine and is present at birth.
- Infantile scoliosis is diagnosed from birth to three years old and is a nonstructural issue. Many infantile cases are termed “idiopathic” (cause unknown).
- Neuromuscular scoliosis is developed as a secondary symptom of another condition, such as spina bifida or cerebral palsy.
Around 90 percent of infantile scoliosis cases cure themselves. The remaining 10 percent of children with progressive curves must be treated without delay.
Early Treatment for Progressive Infantile and Early Onset Scoliosis
There are a variety of treatments for progressive infantile scoliosis, and include bracing and casting, halo gravity traction and an assortment of different distraction hardware procedures depending on the severity of the condition.
Early Treatment (ET) with Mehta’s Growth Guidance Casting, a specialized form of EDF (elongation, derotation, flexion) casting, has been proven to correct the spines of young patients, gently and permanently. ET consists of a series of EDF plaster of Paris casts (covered with a light layer of fiberglass) created on a specialized, pediatric sized, 3-dimensional casting frame. The frame provides elongation through corrective traction and gives the surgeon the ability to effectively address derotation of spine and maintenance/correction of the patients lumbar lordosis via the flexion component. The corrective process is most effective during the child’s rapid phase of growth from birth to 2 years old (24 centimeters), but recent studies reveal that Mehta casting is a superior delay tactic in buying valuable growth time for young scoliosis patients that missed their window at a permanent cure.
The ET approach was developed by UK spine specialist of Emeritus status, Min Mehta, MD., FRCS, and is the only clinically validated, non-surgical method that has the ability to completely resolve scoliosis in young patients.
While there is a growing body of research to support ET with Mehta casting instead of surgery for many cases, unfortunately, Mehta casting cannot cure all spine curvatures, and some children may still require surgical intervention. Please speak to your child’s pediatric orthopedic surgeon about all options because the risk of serious complications resulting from repeated and invasive surgeries is tremendous, and the window for a cure with casts is birth to two years of age.
Total Body Approach
When choosing a plan of care for your child’s scoliosis, it is necessary to understand how the curvature affects the entire body. Keep in mind that scoliosis occurs 3-dimensionally and that the body will do whatever is necessary to keep the head in line with the pelvic structure. This will look differently for each child, depending on the type and degree of curvature. A curved spine often affects the way a child holds his/her neck, shoulders, hips, arms, or legs to compensate for imbalances. In mild cases, deformity is less noticeable, and there is less danger to internal organs. Severe scoliosis (80+degrees) can potentially affect not only the spine and rib cage, but also, may eventually affect the heart, lungs, and other internal organs. Children with severe scoliosis frequently use compensating postures in an attempt to alleviate pain and the imbalance they feel in their body. These compensating postures, used over a length of time, can result in abnormal posture habits and walking gaits, which, in turn, may cause other problems. Parents, who see their children in normal day to day settings, have the unique responsibility of noting how the scoliosis is affecting their child and can act as an advocate to bring this to the attention of the treatment team. The goal, ideally, is to address progressive infantile scoliosis early with a series of POP jackets (Mehta Method), before severe complications develop.
The one internal organ most frequently affected by severe scoliosis is the lungs. Severe scoliosis in the thoracic area of the spine (upper back) causes chest wall deformities, which can push the lungs into abnormal, restrictive shapes. Severe thoracic curves can also change the position of the bronchi–the two tubes that carry air to the lungs. When this occurs, maximum, balanced, lung volume may not be attained resulting in stunted lung growth. In the most extreme cases restricted, and thus unused, portions of lung tissue may die off and cannot re-grow in the restricted environment. Abnormally restricted lungs can also inhibit the circulation of oxygen traveling through the blood causing the need for supplemental oxygen. In critical cases, a tracheotomy surgery is required and ventilator dependence can occur. Since lung tissue will re-grow only until about age 8, it is important to prevent thoracic scoliosis from progressing to the point that the lungs are in danger. Children with moderate to severe thoracic scoliosis may require Bi-Pap or other breathing exercises to teach them to breath in and out more deeply to promote lung health. These interventions are usually prescribed by a pulmonolgist. Children with severe scoliosis may also experience fluid pooling in restricted lung areas causing infection and/or patches of pneumonia. A pulmonologist may prescribe Chest Percussion Therapy (CPT). This therapy is used to break up these secretions so the child can cough them out before infection occurs.
Severe thoracic scoliosis is also dangerous for children previously diagnosed with heart complications. The imbalance in posture, the decrease of air intake, and the decrease in proper oxygen distribution to the lungs through the blood veins puts extra stress on the heart. Also, the restrictive shape of the lungs, and the shifting of other internal organs can crowd the heart. If a child has had heart surgeries and, subsequently, experiences a high degree of thoracic spine curvature, a progressive curve can jeopardize the valuable work done to repair the heart.
Severe scoliotic curves can cause changes in balance and body alignment. Depending on where the scoliosis is focused, and the degree of curvature, a child may adopt compensating positions in an attempt to offset, or counteract, the imbalance felt. This may include: tilting the head, hunching the shoulders, hugging one arm to the body, leaning over to one side, standing with one foot flat and with one foot on tip-toes, pivoting the waist to one side, and turning feet in different directions. New postures may also be adopted to facilitate comfortable sitting, walking, and running as well. Physical therapy can play a great role in preventing muscle tightening and weakness.
Parents of children with progressive infantile scoliosis have found it valuable to keep copies of all medical documentation on hand. Having the documentation enables them to track treatment progress and remain fully informed. Medical case management services are very helpful for children who have scoliosis combined with other complicated conditions. Many case management services provide a personal coordinator who is responsible for managing communication between medical specialties (i.e. orthopedics, pulmonology, cardiology, urology, genetics, physical therapy). This person also tracks documentation regarding office visits, tests, setbacks, progress, and needs. With these details looked after, the parent is freed to focus on the child’s daily physical and emotional needs throughout their scoliosis treatment.
Realizing the impact of scoliosis on the child’s entire body is one of the best arguments for refusing to “wait and watch” a child’s scoliotic curve worsen. More is at stake than the cosmetic appearance of the curve and the possibility for curve reduction. A total body approach recognizes that scoliosis, allowed to reach high degrees of curvature, poses a threat to the function of the child’s entire body. Too much success has been attained in early treatment with a serial corrective plaster (Mehta Method)for progressive infantile scoliosis to allow children to reach curves that endanger their entire body. Parents must be willing to educate themselves and then seek out competent professionals who will treat their children early in the progressive infantile scoliosis diagnosis.