There are several classifications when we talk about scoliosis, one of which is classification according to cause. It can be divided into two main groups. One group includes idiopathic scoliosis, where the cause is unknown — we can say that these cases are multifactorial and account for about 80% of all people with scoliosis. The remaining 20% are cases where the cause is known, including congenital, neuromuscular, neuropathic, and syndromic scoliosis. In the following text, we will discuss the idiopathic type of scoliosis that appears in early childhood. It is also necessary to clarify the classification according to the age at which scoliosis appears: 1. Infantile, occurring between 0 and 3 years of age; 2. Juvenile, between 4 and 9 years of age; 3. Adolescent, over 9 years of age; 4. Adult scoliosis, after the age of 18.
In this article, we will focus more on idiopathic scoliosis that appears during early growth and development — the infantile type of scoliosis.
The period during which infantile scoliosis occurs is usually a period of rapid growth and development, which means that there is a significant risk of worsening of the scoliotic curve during this stage. This type of scoliosis is more common in boys and is usually left-oriented in the thoracic region, often accompanied by a kyphotic pattern.
In people without spinal deformity, the spine is never completely straight and symmetrical; a slight rotation of the vertebrae is always present. During childhood, in children without spinal deformity, the vertebrae in the thoracic region are oriented to the left, and therefore, when scoliosis develops, the spine follows this already existing rotational pattern. This explains why scoliosis in early childhood is most commonly left-oriented.
Throughout life, the existing rotation changes. In the infantile period, the thoracic spine is oriented to the left; in the juvenile period, it is more or less in a central position; while in the adolescent period, it becomes oriented to the right. The change in the natural rotation of the spine can be explained by changes in the size of the organs during different stages of life.
In the infantile period, scoliosis can often be associated with kyphosis, resulting in so-called kyphoscoliosis. Young children are naturally in a kyphotic posture, which is why, when a spinal deformity develops, it continues to follow the already existing pattern.
There are two forms of infantile scoliosis: progressive and resolving, or spontaneously resolving. In 80% of cases, the condition resolves spontaneously without intervention. It is considered that curves of less than 25 degrees, in which there is no overlapping of the rib head and the vertebral body, which can only be seen on an X-ray, will not progress. Moreover, the scoliotic curve may correct spontaneously during growth.
However, 20% of cases are progressive scoliosis, and the prognosis, if left untreated, is quite serious. This type of scoliosis causes significant rib rotation and deformity of the entire thoracic cage, leaving reduced space for lung development. This can lead to serious pulmonary and cardiorespiratory problems.
One of the most important factors is early diagnosis. Based on X-ray and clinical examination, the physician determines what type of treatment is necessary. The earlier the first signs of scoliosis are noticed and treatment is started, the greater the potential effect on reducing the progression of the scoliotic curve.
