Published online Apr 22, 2016.
https://doi.org/10.4055/jkoa.2016.51.2.117
Juvenile Idiopathic Scoliosis
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.
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
Table 2
Summary of the Surgical Techniques Used Recently
CONFLICTS OF INTEREST:The authors have nothing to disclose.
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