Idiopathic Scoliosis

Juvenile

Observation

Side-view MRI showing syrinx (cyst) in a 7-year-old boy with a 30° scoliosis.

Figure 1: An MRI of a 7-year
old boy with scoliosis.

Observation is usually the first method of treatment for a young child with a spinal deformity. The physician will first need to determine if the curvature is progressing – that is, getting worse. In some children, the curve is stable and unchanging. However, other children have curves that progress quickly. Juvenile curves that reach 30^o tend to continue to worsen without treatment. Just because the scoliosis surgeon is “observing” you child does not mean that he/she is not treating them. During this period of observation, changes in the curve are monitored, and special tests may be ordered. These tests may include an MRI or a CT study. Your child may be referred to other specialists, such as a geneticist, cardiologist, or pulmonologist to make sure there are no other problems in other parts of the body.

The most basic way to monitor the curves is through standing X-rays. X-rays today have a small fraction of the radiation they did several years ago. Your spine surgeon will probably want to see your child every four to six months and have new front- and side view X-rays made. They will then measure the curves and compare them with prior films. It is a good idea to bring old X-rays (or discs with the images) to each evaluation. To make things simpler, it is ideal to have all the X-rays done at your scoliosis surgeon’s office so that he/she can obtain the proper studies, and compare them properly. Doctors may obtain special bending radiographs to assess the flexibility of the curve(s).

Special studies as MRI or CT are sometimes necessary to look for abnormalities in the bones or pressure on the nerves. An MRI study is often done to evaluate the spinal cord and find any abnormalities that may be causing the scoliosis or kyphosis (round back) (see Figure 1). In children, sedation or general anesthesia is usually necessary to relax the child. A CT scan may be necessary to rule out bony anomalies.

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