The type of idiopathic scoliosis that appears between the ages of 4 and 9 is called juvenile scoliosis. The period during which juvenile scoliosis occurs is characterized by much slower growth and development of the child and, therefore, much slower progression of the scoliotic curve. Juvenile scoliosis is also the rarest form of scoliosis. It is a fact that boys reach skeletal maturity later than girls, and in boys juvenile scoliosis appears slightly earlier, around the age of 5, while in girls it is usually diagnosed around the age of 7.
Most commonly, this type of scoliosis is right-oriented in the thoracic region and left-oriented in the lumbar region — the so-called S-shaped curve. Unlike infantile scoliosis, spontaneous resolution of the scoliotic curve occurs less often in juvenile scoliosis.
Newborns have 6% of the total lung capacity of an adult. By the age of 5, 30% of the total lung volume has developed, and by the age of 10, 50% of the total lung volume has developed. When a scoliotic curve worsens, serious deformities of the thoracic cage occur, reducing the available space for lung development. This is why there is a greater likelihood of pulmonary and cardiorespiratory problems when scoliosis develops during the juvenile or infantile period than when scoliosis develops later.
This problem can be addressed through surgical and non-surgical approaches. Non-surgical, or conservative, treatment includes observation and regular follow-up of the child, brace treatment, and exercises for general strengthening and stabilization of the body. The brace primarily serves to stabilize the scoliotic curve. When brace treatment is required, the orthotist determines which type of brace would be most appropriate for the child.
Choosing the right type of brace is of great importance, mainly because the ribs in young children are much more flexible than in adolescents. An inadequate brace can cause deformation of the thoracic cage by pushing the ribs toward the spine and increasing rib rotation. In young children, the brace should focus more on three-dimensional derotation and correction of thoracic cage deformities — that is, stopping the rotation of the thorax — rather than on reducing the size of the scoliotic curve, if the curve is not large.
The Schroth Method has proven to be the most effective type of treatment for scoliosis correction. However, due to its complexity, it is very difficult to apply Schroth exercises in children under the age of 7. Nevertheless, it is possible to apply the Schroth principle, which can stop or slow further progression. When applying the Schroth Method, it is always important to establish a good plan and program and, in this way, set a clear goal. For this age group, a very effective way to correct scoliosis using the Schroth Method is to use Schroth positioning and the Schroth principle without three-dimensional breathing. In addition to this approach, exercises for general stabilization and overall strengthening of the body through correct body positions should also be applied.
The main goal of the conservative approach is to slow or stop the progression of the deformity, thereby delaying and, if possible, avoiding surgery. Due to possible complications, it is always preferable to postpone surgical treatment at this age whenever possible. Early diagnosis is one of the most important factors influencing the final outcome. Early detection of scoliosis at the very beginning of its development is also the best way to prevent future complications. Regular monitoring of the child, brace control, and the exercises performed by the child are essential parts of treatment in order to achieve the best possible results.
