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Abstract Background The recommended treatment for mild to moderate infantile idiopathic scoliosis curves involves serial casting. There are concerns, however, regarding the safety of repeated casting in very young children owing to the requirement for anesthetization during the casting process. Very little research has been conducted on the influence of bracing as an initial treatment for scoliosis in this age group. This report details the successful treatment of a large thoracic curve using a thoracolumbosacral orthosis in an infant diagnosed with infantile idiopathic scoliosis. Case presentation The Dutch-Australian patient presented at 11 weeks of age with a 44° thoracic scoliosis and a rib vertebral angle difference of 14°. The history and physical examination failed to reveal a cause of the curvature, and a diagnosis of infantile idiopathic scoliosis was made. The patient was prescribed a thoracolumbosacral orthosis (ScoliBrace) to be worn on a part-time basis for a period of 8 months. At the end of the bracing program, the patient’s curve had been reduced to 7° and a rib–vertebral angle difference of 0°. A final follow-up of the patient at 2 years after the cessation of treatment revealed no evidence of scoliosis. The parents were compliant with the bracing protocol and reported that the treatment was tolerated by the infant. Conclusion The use of an orthosis as a standalone treatment in this patient resulted in significant reduction in a large thoracic scoliosis. Based on the results witnessed in this patient, further investigation into bracing as an alternative to casting is warranted.

Background: The recommended treatment for mild to moderate infantile idiopathic scoliosis curves involves serial casting. There are concerns, however, regarding the safety of repeated casting in very young children owing to the requirement for anesthetization during the casting process. Very little research has been conducted on the influence of bracing as an initial treatment for scoliosis in this age group. This report details the successful treatment of a large thoracic curve using a thoracolumbosacral orthosis in an infant diagnosed with infantile idiopathic scoliosis.Case Presentation: The Dutch-Australian patient presented at 11 weeks of age with a 44° thoracic scoliosis and a rib vertebral angle difference of 14°. The history and physical examination failed to reveal a cause of the curvature, and a diagnosis of infantile idiopathic scoliosis was made. The patient was prescribed a thoracolumbosacral orthosis (ScoliBrace) to be worn on a part-time basis for a period of 8 months. At the end of the bracing program, the patient's curve had been reduced to 7° and a rib-vertebral angle difference of 0°. A final follow-up of the patient at 2 years after the cessation of treatment revealed no evidence of scoliosis. The parents were compliant with the bracing protocol and reported that the treatment was tolerated by the infant.Conclusion: The use of an orthosis as a standalone treatment in this patient resulted in significant reduction in a large thoracic scoliosis. Based on the results witnessed in this patient, further investigation into bracing as an alternative to casting is warranted. [ABSTRACT FROM AUTHOR]

Abstract Background Serial casting is a treatment for early onset scoliosis (EOS) in young children to achieve curve correction before bracing or to postpone initial surgical treatment until the patient is older. Good results have been reported for patients with idiopathic early onset scoliosis (IS). However, there are few reports of results in non-idiopathic cases, and the benefits of non-surgical methods in the syndromic-associated early onset scoliosis subgroup are unknown. Methods Retrospective single-institution study of patient charts and X-rays of all cases of sustained serial casting for EOS. Staged correction was obtained by applying three consecutive casts under general anaesthesia. These were changed every 4 weeks, followed by the implementation of a custom-made full-time Chêneau brace. Correction was measured by Cobb angle (CA) and rib-vertebra angle difference (RVAD) on whole spine anterior-posterior radiographs. Statistical analysis was performed via ANOVA. Results The study group consisted of 6 patiens with IS and 10 with non-idiopathic scoliosis (NIS) – exclusively syndromic-associated. The mean age at onset of treatment was 35 months (±15). The mean follow up was 21 months (±15). In IS patients average CA/RVAD before treatment was 46°(±8)/20°(±12). In NIS patients average CA/RVAD before treatment was 55°(±15)/24°(±14). After application of the third cast, the CA/RVAD was reduced to 20°(±11)/11°(±10) in IS patients. Whereas in NIS patients average CA/RVAD after the thrid cast was 28°(±12)/18°(±13). At latest follow-up the CA/RVAD was 16°(±7)/9°(±8) in IS patients and 31°(±11)/17° (±15) in NIS patients. Conclusion Syndromic etiology is not a contraindication for serial casting in EOS. Our results show a curve correction, measured in CA, of 65% in IS patients and 44% in NIS patients. Significant reduction in the morphologic deformity, measured in RVAD, was achieved in the IS cohort, but not in the NIS cohort. In all cases surgical treatment could be delayed.

Elongation-de-rotation-flexion (EDF) casting is a popular treatment for early-onset-scoliosis (EOS). However, casting every 2 to 3 months using general anesthesia may affect cognitive function.[1,2] Aims of this study: 1) to develop a new orthosis for EOS treatment based on EDF technique (EDFO) and traction frame; 2) to evaluate emerging radiographic results from treatment. Mehta’s EDF serial casting method and AMIL traction frame were used to manually correct the spine for 3D trunk scan. Afterward, a digital spinal model was created and helped design the EDFO with CAD/CAM technology. Radiographic measurements included Cobb angle, RVAD, and thoracic height and width. Six patients (2 girls; 4 boys) diagnosed with idiopathic EOS were enrolled in the study. EDFO was applied at mean 36.5 months of age, after final EDF casting. The average major Cobb angle stabilized after treatment. Average RVAD increased. The average normalized thoracic width at last EDFO out-of-brace was less than prior to EDFO. The new asymmetric EDFO offers an alternative to serial casting and TLSO. EDFO is considered a cost-effective, safer, more breathable, removable, and less invasive modality. [ABSTRACT FROM AUTHOR]

Objective. To analyze results of final surgical treatment for scoliosis in the first decade of life. Material and Methods. In 2008–2016, a total of 95 patients with infantile and juvenile scoliosis were operated on using VEPTR instrumentation. The final stage of surgical treatment was performed in 14 patients (9 girls, 5 boys). The average age at the start of treatment was 5.4 ± 2.1 years, average follow-up period – 2 years (6–36 months). Results. Average value of the primary scoliotic curve before surgery was 83.0° ± 14.8°, thoracic kyphosis 41.1° ± 11.9°, lumbar lordosis 49.5° ± 4.9°. At the last follow-up average value of the primary scoliotic curve was reduced to 56.8° ± 14.1°, thoracic kyphosis to 24.5° ± 8.5°, lumbar lordosis to 38.4° ± 5.1° (p < 0.05). Space available for lung before surgery was 84.5 ± 8.7 %, after surgery 94.8 ± 6.7 %, at the last follow-up it increased to 98.6 ± 5.4 %. Complications included 9 cases of instability of implant anchors and 1 case of suppuration. There were no neurological complications. Conclusion. Stage correction using different instrumentations is a method of choice for surgical treatment of infantile and juvenile scoliosis.

The tactics of surgical treatment of patients with spinal deformities associated with multiple malformations is of great importance because of aggressive course of disease, limited opportunities for radical correction of deformity, and a high risk of complications. The review analyzes the literature devoted to this problem. The theoretical basis behind the need for surgical treatment is considered. The current methods of surgical intervention are presented, and their principal ideological and practical differences are demonstrated. Surgical treatment of patients with spinal deformity associated with multiple malformations is of particular interest in the practice of a spine specialist. Most patients at an early age require multi-stage surgical treatment which threatens to entail serious complications. In order to minimize risks and improve the final result of treatment, it is necessary to apply existing surgical techniques, as well as correctly arrange a sequence and frequency of their implementation.

Idiopathic scoliosis (IS) is the most common type of musculoskeletal defect affecting children worldwide, and is classified by age of onset, location and degree of spine curvature. Although rare, IS with onset during infancy is the more severe and rapidly progressive form of the disease, associated with increased mortality due to significant respiratory compromise. The pathophysiology of IS, in particular for infantile IS, remains elusive. Here, we demonstrate the role of PRMT5 in the infantile IS phenotype in mouse. Conditional genetic ablation of PRMT5 in osteochondral progenitors results in impaired terminal hypertrophic chondrocyte differentiation and asymmetric defects of endochondral bone formation in the perinatal spine. Analysis of these several markers of endochondral ossification revealed increased type X collagen (COLX) and Ihh expression, coupled with a dramatic reduction in Mmp13 and RUNX2 expression, in the vertebral growth plate and in regions of the intervertebral disc in the Prmt5 conditional mutant mice. We also demonstrate that PRMT5 has a continuous role in the intervertebral disc and vertebral growth plate in adult mice. Altogether, our results establish PRMT5 as a critical promoter of terminal hypertrophic chondrocyte differentiation and endochondral bone formation during spine development and homeostasis. This article has an associated First Person interview with the first author of the paper.

The paper presents a second part of literature review on basic methods of treatment of patients with infantile and juvenile scoliosis. Particular attention is paid to the results of treatment with the use of various instrumentation and with a possibility of stage correction.

The paper presents the first part of literature review of the main methods of treatment of patients with infantile and juve- nile scoliosis. Particular attention was paid to the results of treatment using various instrumentation with the possibility of stage correction.

Background Context: Perioperative visual loss (POVL) after spinal deformity surgery is an uncommon but severe complication. Data on the incidence and risk factors of this complication after corrective surgery in the pediatric population are limited.Purpose: The present study aimed to investigate nationwide estimates of POVL after corrective surgery for pediatric scoliosis.Study Design: This is a retrospective study that uses a nationwide database.Patient Sample: The sample includes 42,339 patients under the age of 18 who underwent surgery for idiopathic scoliosis.Outcome Measures: The outcome measures were incidence of POVL and risk factors.Methods: Patients under the age of 18 who underwent elective surgery for idiopathic scoliosis between 2002 and 2011 were identified using the Nationwide Inpatient Sample database. The incidence of POVL (ischemic optic neuropathy, central retinal artery occlusion, or cortical blindness) was estimated after application of discharge weights. Demographics, comorbidities, and operative parameters were compared between patients with and without visual loss. A multivariate logistic regression was performed to identify significant risk factors for POVL development. No funds were received in support of this work.Results: The incidence of POVL was 1.6 per 1,000 procedures (0.16%). Patients with visual loss were significantly more likely to be younger and male, have Medicaid as insurance, and undergo fusion of eight or more spinal levels compared with patients without visual loss. Following multivariate analysis, older patients (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.77-0.91) and female patients (OR: 0.08; 95% CI: 0.04-0.14) were significantly less likely to develop POVL compared with younger and male patients. On the other hand, having Medicaid as insurance (OR: 2.13;95% CI: 1.32-3.45), history of deficiency anemia (OR: 8.64; 95% CI: 5.46-14.31), and fusion of eight or more spinal levels (OR: 2.40; 95% CI: 1.34-4.30) were all independently associated with POVL.Conclusions: In this nationwide study, the incidence of POVL after scoliosis surgery in patients under the age of 18 was estimated at 0.16%, similar to the rate reported in adult patients. Cortical blindness accounted for all cases of POVL in the present study. Younger patients, patients with history of deficiency anemia, and patients undergoing long-segment fusions may be at increased risk of POVL after corrective surgery for pediatric scoliosis. [ABSTRACT FROM AUTHOR]

Derotational casting plays an important role in the management of early-onset scoliosis. It appears to be a potential cure in smaller curves, but it is an important surgical delaying tactic in a disorder where all surgical treatments have common complications. Proper casting technique is important and is delineated in this article. [ABSTRACT FROM AUTHOR]

Early Onset Scoliosis (EOS) may be associated with long-term pulmonary morbidity, which is not commonly seen in Adolescent Idiopathic Scoliosis. Initial evaluation is based on determining any underlying etiology related to congenital or syndromic conditions. Assessing the impact of scoliosis on thoracic development may help guide treatment, which is often required at a young age in these children to prevent irreversible pulmonary insufficiency. Treatment is based on multiple factors but may include non-surgical strategies, such as casting or bracing, along with growth-sparing surgical procedures using growing rods or chest wall expansion. Definitive fusion is rarely indicated in young patients. This chapter will cover the diagnosis, evaluation, and treatment of children with EOS. [ABSTRACT FROM AUTHOR]

The article presents a study on the accuracy and safety of pedicle screws placed in infants and juvenile patients aged nine years old and below. The accuracy of pedicle screw placement was evaluated using a radiographic review conducted by spinal surgeons who were not part of the surgical treatment. Results revealed patients who were required to undergo revision surgery.

Abstract: Purpose: Vertical expandable prosthetic titanium rib (VEPTR) insertion and expansion has been advocated to increase thoracic volume and pulmonary function in patients with thoracic insufficiency syndrome. We reviewed our experience with VEPTR implantation to determine if lung function and growth is augmented, to determine the children''s functional status, and if the scoliosis is controlled. Methods: From 2006 to 2010, 29 insertions and 57 expansions were performed in 26 patients at our institution. Demographic data were reviewed in conjunction with complications, scoliosis angles, pulmonary function tests (PFTs), and computed tomography–guided 3D reconstructions to determine lung volumes; and quality of life scores were determined using a modified Scoliosis Research Society (SRS) questionnaire preoperatively and postoperatively. The groups were also stratified by age (because of lung growth potential), disease (congenital or infantile scoliosis, Jeune syndrome, neuromuscular, other structural thoracic disorders), and sex. Analyses using SPSS (SPSS, Chicago, Ill) were performed with P < .05 considered significant. Results: Each patient underwent 3.03 ± 1.8 surgeries, spending 0.97 ± 1.8 days in the intensive care unit and 4.41 ± 6 days in the hospital for each procedure. Mean age was 90.7 ± 41 months. Of the 36 complications, most were because of infection (12), half requiring operative repair (hardware removal). The average PFT percent predicted values for forced expiratory volume in 1 second, forced vital capacity, and RV were 54.6 ± 22, 58.1 ± 24, and 145.3 ± 112, respectively, preoperatively and 51.8 ± 20, 55.9 ± 20, and 105.6 ± 31, respectively, postoperatively. The lung volumes measured by computed tomography when corrected for age do not increase significantly postoperatively. The mean Cobb measurement for the preoperative major curves was 64.7° and postoperatively was 46.1° for those curves measured preoperatively, for a 29% curve improvement. All postoperative curves had a mean of 56.4° and 58.1° at final follow-up, a 3% curve increase. The SRS scores for patients remained unchanged and no statistical difference was seen from preoperative to postoperative values. No statistically significant difference was seen in complications, PFT (forced expiratory volume in 1 second, forced vital capacity, RV), lung volumes, scoliosis angles, and SRS scores between sex, age, and disease categories. Conclusion: There was mild improvement in scoliosis angles but no improvement in lung function and volume. Scoliosis Research Society scores indicate that the children have near normal function both before and after VEPTR placement. Pulmonary function, lung volume, and patient subjective assessments did not increase dramatically after VEPTR placement, although scoliosis angles improved. [Copyright &y& Elsevier]

Most cases of scoliosis are diagnosed and treated during adolescence; many are detected in school screening programs. For a small percentage of children, however, the onset of scoliosis occurs much earlier than adolescence. Infantile scoliosis (ie, onset from birth to two years of age) and juvenile scoliosis (ie, onset from three to nine years of age) involve very different diagnoses and treatment regimens than adolescent scoliosis. Early onset scoliosis may resolve with growth or may require nonsurgical treatment (eg, orthosis, body cast); surgical intervention (eg, halo traction, growing rods, vertical expandable prosthetic titanium rib); or a combination of both. [ABSTRACT FROM AUTHOR]

The article offers information on a study that evaluates the early intervention in congenital scoliosis. It states that the study involves 41 children with congenital scoliosis who were operated on by hemivertebra resection using a posterior only approach with transpendicular instrumentation. Findings reveal that hemivertebra resection that employs a posterior approach with transpendicular instrumentation is an ideal technique for early correction of congenital scoliosis in children.

Casting for infantile scoliosis is a nearly forgotten but useful technique for treating progressive early onset scoliosis, which can result in either cure for younger children with smaller curves or delay in the need for surgery in others. The proper technique focuses on the rotational component of the curve and avoids pushing the convex ribs further into the chest. [Copyright &y& Elsevier]

Abstract: Background context: Progressive scoliosis alters lung function by reducing chest wall compliance and excursion and rotating intrathoracic contents, producing an increasingly asymmetric lung size. The effect of this distortion on regional lung perfusion and ventilation has not been described in children with congenital and infantile forms of scoliosis. The severity of scoliosis is often described by the Cobb angle of the spine, but the relationship between Cobb angle and lung function asymmetry between concave and convex lungs has not been described in this group of children. Purpose: To describe the frequency of asymmetric lung perfusion and ventilation among children with congenital or infantile thoracic scoliosis before surgical treatment and the relationship between Cobb angle and asymmetry of lung function. Study design/setting: Prospective comparison of lung perfusion scans and spine film findings in children evaluated in two pediatric spine referral clinics for expansion thoracoplasty and vertical expandable prosthetic titanium rib (VEPTR) implantation. Patient sample: Thirty-nine children, aged 1 year 8 months to 15 years 6 months, with congenital or infantile forms of scoliosis who are clinically stable outpatients and have neither primary pulmonary disease nor neuromuscular weakness. Outcome measures: 1) Cobb angle measurements from weightbearing spine films and 2) right and left contributions to total lung perfusion and total lung ventilation compared with normal values. Methods: Lung perfusion scans using technetium-labeled albumin macroaggregates were performed in all children; 15 of the children also underwent ventilation lung scans using aerosolized technecium-labeled diethylenetriaminepentaacetic acid (DTPA). The degree of asymmetry between right and left lung function from the normal right-to-left lung distribution was correlated with the Cobb angle of the spine. Ventilation and perfusion asymmetry between right and left lungs was also compared. Results: Sixteen of the 25 children with congenital scoliosis had fused ribs; 13 additional children had infantile scoliosis. Cobb angles ranged from 30° to 112° in the group (median=71°), with the concave lung being the left lung in 61% of cases. Lung function relations between the right and left lungs were abnormal (>5% deviation from the normal 55% right [R]/45% left [L]) in 21 (54%) patients. Right-left contributions to lung perfusion ranged from 86% R/14% L to 26% R/74% L among the 39 children. Lung function in the concave lung was reduced below the normal proportion in only 20 children (51%). Lung function asymmetry, measured as the deviation from the normal contributions of the right and left lungs, did not correlate with Cobb angle values (r=.14, p=.4). Ventilation asymmetry and perfusion asymmetry were concordant and correlated closely (r=.93, p<.0001). Conclusions: Asymmetric ventilation and perfusion between the right and left lungs occurs in more than half of the children with severe congenital and infantile thoracic scoliosis. However, the severity of lung function asymmetry does not relate to Cobb angle measurements. Asymmetry in lung function is influenced by deformity of the chest wall in multiple dimensions, and cannot be ascertained by chest radiographs alone. [Copyright &y& Elsevier]

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Copyright of International Orthopaedics is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Serial casting is a treatment for early onset scoliosis (EOS) in young children to achieve curve correction before bracing or to postpone initial surgical treatment until the patient is older. Good results have been reported for patients with idiopathic early onset scoliosis (IS). However, there are few reports of results in non-idiopathic cases, and the benefits of non-surgical methods in the syndromic-associated early onset scoliosis subgroup are unknown.Methods: Retrospective single-institution study of patient charts and X-rays of all cases of sustained serial casting for EOS. Staged correction was obtained by applying three consecutive casts under general anaesthesia. These were changed every 4 weeks, followed by the implementation of a custom-made full-time Chêneau brace. Correction was measured by Cobb angle (CA) and rib-vertebra angle difference (RVAD) on whole spine anterior-posterior radiographs. Statistical analysis was performed via ANOVA.Results: The study group consisted of 6 patiens with IS and 10 with non-idiopathic scoliosis (NIS) - exclusively syndromic-associated. The mean age at onset of treatment was 35 months (±15). The mean follow up was 21 months (±15). In IS patients average CA/RVAD before treatment was 46°(±8)/20°(±12). In NIS patients average CA/RVAD before treatment was 55°(±15)/24°(±14). After application of the third cast, the CA/RVAD was reduced to 20°(±11)/11°(±10) in IS patients. Whereas in NIS patients average CA/RVAD after the thrid cast was 28°(±12)/18°(±13). At latest follow-up the CA/RVAD was 16°(±7)/9°(±8) in IS patients and 31°(±11)/17° (±15) in NIS patients.Conclusion: Syndromic etiology is not a contraindication for serial casting in EOS. Our results show a curve correction, measured in CA, of 65% in IS patients and 44% in NIS patients. Significant reduction in the morphologic deformity, measured in RVAD, was achieved in the IS cohort, but not in the NIS cohort. In all cases surgical treatment could be delayed. [ABSTRACT FROM AUTHOR]