When is treatment indicated in infantile idiopathic scoliosis?

Updated: Dec 02, 2020
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Nonoperative treatment of progressive infantile idiopathic scoliosis predominates and may involve the use of conventional thoracolumbosacral orthosis (TLSO)-type braces, Milwaukee-type braces, and even intermittent Risser casting. Some have questioned the value of bracing in infantile idiopathic scoliosis and have stated that "a curve that resolves in a brace would probably have resolved without treatment." [88]

If surgical treatment becomes necessary, anterior release and fusion followed by posterior spinal fusion with instrumentation is considered to be the functional treatment. Every effort should be made to delay such surgical intervention as long as possible to optimize spinal growth, but relentless curve progression should not be accepted or tolerated while some arbitrary chronologic age is awaited.

Although convex spinal epiphysiodesis (which has been shown to be quite effective in the management of congenital scoliosis) is intuitively attractive, it has not been shown to be as reliable in the setting of infantile idiopathic scoliosis. [93] Addition of some type of posterior instrumentation may improve the results of epiphysiodesis. [94]


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