Juvenile Idiopathic Scoliosis

Min Seok Kang; Seung Woo Suh; Seungjin Choi; Jin-Ho Hwang

doi:10.4055/jkoa.2016.51.2.117

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Kang, Suh, Choi, and Hwang: Juvenile Idiopathic Scoliosis

Symposium

Common Problems in Skeletally Immature Patients

Journal of the Korean Orthopaedic Association 2016; 51(2): 117-124.

Published online: 22 April 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.2.117

Juvenile Idiopathic Scoliosis

Min Seok Kang, M.D., Seung Woo Suh, M.D.^*, Seungjin Choi, M.D.^†, Jin-Ho Hwang, M.D.^†

Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea.

^*Department of Orthopedic Surgery, Korea University School of Medicine, Seoul, Korea.

^†Department of Orthopedic Surgery, Yonsei University School of Medicine, Seoul, Korea.

Correspondence to: Jin-Ho Hwang, M.D. Department of Orthopedic Surgery, Yonsei University School of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. TEL: +82-2-2228-2180, FAX: +82-2-363-1139, osjinho@naver.com

Received 28 July 2015 Revised 30 November 2015 Accepted 3 February 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Juvenile idiopathic scoliosis includes scoliosis diagnosed from three to ten years old according to the chronological age. Spine growth in juveniles does not occur at a rapid rate spinal deformity does not show rapid progress. However, because of the intimate relationship between chest wall growth and the spine, decrease of chest wall capacity due to scoliosis could lead to development of cardiovascular and pulmonary complication, especially in early age. In scoliosis in early age, other causes of the deformity including neurological problems should be evaluated. If the scoliosis angle is more than 25 degrees, it could progress very easily, thus aggressive treatment is needed. A new growing-sparing surgical technique (growing rod and growth modulation) is introduced for improvement of spine and chest growth, and for prevention of crankshaft phenomenon.

Keywords: juvenile idiopathic scoliosis, spinal growth, chest growth, growing rod, growth modulation

Figures and Tables

Figure 1

Spinal growth from ages 1 through 15 years. Spinal growth decelerates during the juvenile period, between the age of 5 and 10 years. There is a second acceleration of the growth rate along with the puberty in the adolescent period. Therefore, early onset scoliosis is often defined as scoliosis that manifests before the age of 5 years, as compared to late onset scoliosis which manifests after the age of 5 years.

Figure 2

Growth of spine and thorax. The thoracic volume is 5% adulthood at birth, which increases to more than 30% at the age of 5 years. Early onset of scoliosis relates to reduced spinal length, which can ultimately lead to decreased thoracic volume and increased risk of pulmonary complications.

Figure 3

Serial radiographs of a 7-year-old boy with an initial deformity curve of 30 degrees. A 1 month follow-up radiograph showed resolution of the curve. After 2 months, a curve measuring 15 degrees is seen again in the radiograph. This case demonstrates the features of juvenile idiopathic scoliosis well.

Figure 4

Tuning/balancing mechanism. Tuning/balancing mechanism is a characteristic feature of juvenile idiopathic scoliosis which the Cobb angle shows variation over time. The process of progression, quit and regression can be seen. Figure shows x is the onset time of scoliosis in growing spine; y is the time when curve will follow one of three pathway (A: regression; B: quit and C: progression); and z is the time of change in treatment approach.

Figure 5

(A) A 6 year and 9 month-old boy with a 29 degree of scoliosis in the radiograph. (B) Magnetic resonance imaging scan of the spine revealed syringomyelia (big arrow) with Chiari malformation (small arrow) in the cord and surgical treatment was performed. (C) After surgery, signs of syringomyelia has improved and the deformity angle remains stable with the conservative treatment of bracing.

Figure 6

Treatment algorithm of juvenile idiopathic scoliosis (JIS). MRI: magnetic resonance imaging.

Table 1

Presenting Symptoms in the Syringomyelia and Chiari Malformation

Values are presented as number only or number (%). Mild degree of neck pain take up a high percentage of the patient's symptom. Scoliosis can be the first presenting sign. HA, headache; CN/BS, cranial nerve/brain stem; NS, not stated.

Table 2

Summary of the Surgical Techniques Used Recently

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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