Infantile Scoliosis

Figure 1: The degree of scoliosis and the Mehta rib
vertebral angle are measured in infantile scoliosis

Infantile idiopathic scoliosis is classically defined as scoliosis that is first diagnosed between birth and 3 years of age. This category comprises about 1% of all idiopathic scoliosis in children. 60% of patients are males. The etiology of the scoliosis remains unknown despite interest in 2 theories. The intra-uterine molding theory suggests that the spine is bent at the time of birth and worsens with growth. The post delivery theory suggests that placing the infant their back will lead to flattening of the skull and scoliosis. Due to the fact that more progressive curves occur in Europe than in the U.S., a genetic cause has been postulated but still unproven.
Evaluation

The diagnosis of idiopathic infantile scoliosis is based on the age of onset, the absence of any other spinal cord problems, the location of the curve, findings on physical examination, and x-rays. The characteristic finding on physical examination is that the curve is typically between the shoulder blades or in the thoracic region of the spine and the spine curves to the left. The MRI is normal in infantile idiopathic scoliosis.
Prognosis

Infantile curves that reach 30 degrees tend to continue to worsen without treatment. In addition to the degree of scoliosis, the Mehta rib vertebral angle degree difference has greater prognostic value. The Mehta angle is determined by identifying the vertebra in the apex or middle of the curve and measuring the difference in the angle of each rib attaching to the vertebra (Figure 1). A Mehta difference of 20 degrees or less is associated with a non progressive or resolving curve in most cases. Girls with right sided curves tend to have more progressive curves than other infants. 25 year follow up studies demonstrate a normal quality of life in patients with non progressive infantile scoliosis.

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