Respiratory function and cosmesis at maturity in infantile-onset scoliosis

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 28; no. 20; pp. 2397 - 2406
• Main Authors: GOLDBERG, C. J, GILLIC, I, CONNAUGHTON, O, MOORE, D. P, FOGARTY, E. E, CANNY, G. J, DOWLING, F. E
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Lippincott 15-10-2003; Hagerstown, MD
• Subjects: Adolescent; Adult; Age of Onset; Biological and medical sciences; Braces; Child; Child, Preschool; Diseases of the osteoarticular system. Orthopedic treatment; Female; Follow-Up Studies; Humans; Infant; Lung - physiopathology; Male; Medical sciences; Orthopedic Procedures - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reconstructive Surgical Procedures - methods; Respiration; Respiratory Function Tests; Retrospective Studies; Scoliosis - pathology; Scoliosis - surgery; Scoliosis - therapy; Treatment Outcome; Human; spinal surgery spinal surgeryl Spine 2003,28.2397-2406; spinal deformity; Deformation; Respiratory disease; Spine; Diseases of the osteoarticular system; infantile- onset scoliosis; Age criterion; pulmonary function; Spine disease; Review; Clinical management; Lung function; Scoliosis; Topography; Aesthetics; Child; Maturity
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/01.BRS.0000085367.24266.CA

Retrospective review of patient records, clinical and radiographic, and patient recall for full pulmonary function studies and surface topography.
Assessment of outcome of treatment policy after age 15 during the previous 30 years to establish the efficacy of management protocols in a group that is too small and too varied for more formal assessment.
Spinal deformity presenting during infancy or early childhood poses a clinical problem caused by small numbers, long growth period, variable presentation and treatment methods, and, finally, the length of time that must pass before meaningful outcome results can be assessed. The aims of treatment are to preserve respiratory function and cosmetic appearance.
The records of patients with infantile onset, nonsyndromic, and noncongenital scoliosis were reviewed. Thirty two were at least age 15 years at the time of review and 21 of these agreed to attend for full pulmonary function testing (spirometry, lung volumes, gas diffusion) and surface topography, whereas two more had recent spirometry results available in their record. Treatment had been serial casting with Risser jacket, bracing, or surgery.
Those whose scoliosis resolved or was stabilized by nonoperative means (N = 6) at an acceptable Cobb angle had normal cosmesis and pulmonary function (mean FEV1 = 98.7%, mean FVC = 96.6%). Those who were managed by casting or bracing and underwent surgery after age 10 (N = 6, mean age at surgery 12.9 y) had variable cosmesis and acceptable pulmonary function (mean FEV1 = 79%, mean FVC = 68.3%). Those whose deformity necessitated early surgery (N = 11, mean age at surgery 4.1 y) had recurrence of deformity and diminished respiratory function (mean FEV1= 41%, range 14%-72%, mean FVC = 40.8%, range 12%-67%).
Although these are small numbers and treatment methods have changed since the beginning of the series, the results indicate that this condition is not simple to treat and for some children still has the risk for serious deformity and respiratory compromise. There is, as yet, no evidence that early surgical intervention in this group of patients with infantile scoliosis has altered their prognosis in any meaningful way.