summary Infantile Idiopathic Scoliosis is a coronal plane spinal deformity which most commonly presents in children ages 3 years or less. Diagnosis is made with full-length PA and lateral spine radiographs. MRI studies are indicated to rule out syrinx, tumor, or tethered cord. Treatment can be observation, bracing, or surgical management depending on the skeletal maturity of the patient, magnitude of deformity, and curve progression. Epidemiology Incidence 4% of idiopathic scoliosis cases Demographics males > females Anatomic location usually left thoracic Risk factors family history Etiology Pathophysiology pathoanatomy may adversely affect growth of alveoli and normal development of the thoracic cage Genetics autosomal dominant with variable penetrance Associated conditions plagiocephaly (skull flattening) congenital defects neural axis abnormalities 22% of patients with curves > 20° will be affected login to view 1 more bullet thoracic insufficiency syndrome characterized by decreased thoracic growth and lung volume leads to pulmonary hypertension and cor pulmonale pulmonary function impairment associated with curves > 60° cardiopulmonary issues associated with curves > 90° Anatomy Osteology the T1-L5 spinal segment grows fastest in the 1st five years of life the height of the thoracic spine increases by 2 times between birth and skeletal maturity Classification Infantile Idiopathic Scoliosis consists of resolving type progressive type Early onst scoliosis early-onset scoliosis is a broader category that includes scoliosis in children < 10 years. It includes infantile idiopathic scoliosis (this topic) juvenile idiopathic scoliosis congenital scoliosis neurogenic scoliosis syndromic scoliosis login to view 2 more bullets Presentation History age deformity was first noticed and any observed progression perinatal history developmental milestones Presentation most present with deformity excessive drooling may reflect neurologic condition Physical exam inspection cafe-au-lait spots (neurofibromatosis) patches of hair dimpling over the spinal region login to view 1 more bullet nevi or other tumors may be indicative of spinal dysraphism plagiocephaly (skull flattening) neurologic motor login to view 2 more bullets upper and lower extremities exam reflexes login to view 5 more bullets gait analysis Imaging Radiographs recommended views standing PA and lateral login to view 1 more bullet findings look for congenital vertebral defects measurements cobb angle login to view 1 more bullet rib phase login to view 6 more bullets RVAD (rib vertebrae angle difference, Mehta angle) login to view 6 more bullets MRI obtain MRI of spine first to rule out tether cyst tumor syrinx (20% incidence) Treatment Nonoperative observation alone (most resolve spontaneously) indications login to view 2 more bullets 90% will resolve spontaneously serial Mehta casting (derotational) or thoracolumbosacral orthosis (TLSO) indications login to view 4 more bullets mechanism login to view 2 more bullets bracing indications login to view 2 more bullets Operative growing rod construct (dual rod or VEPTR) indications login to view 2 more bullets fusion login to view 2 more bullets outcomes login to view 1 more bullet Techniques Growing rod construct (dual rod or VEPTR) permits growth of affected part of spine up to 5 cm dual rods or VEPTR use anchors proximally and distally serial lengthening login to view 1 more bullet Complications High rate of complications with surgical treatment Prognosis Progression most resolve spontaneously if progressive by age 5, >50% of children will have a curve > 70° Mehta predictors of progression Cobb angle > 20° RVAD > 20° phase 2 rib-vertebral relationship (rib-vertebral overlap) Prognosis progressive curves have poor outcomes and must be treated can be fatal if not treated appropriately