How is infantile idiopathic scoliosis treated

Resolving curves are observed with serial physical examinations and radiographic monitoring. Sleeping in the prone position is recommended because supine positioning has been associated with infantile curves by some investigators. Progressive curves are treated with serial casting followed by orthotic treatment with a Milwaukee brace. Curves that continue to progress despite orthotic treatment require surgery. Options include posterior spinal instrumentation without fusion or the vertically expandable prosthetic titanium rib (VEPTR). These are growth-preserving procedures that permit delay of definitive fusion until the child has achieved additional growth. Posterior spinal instrumentation and fusion are not recommended due to: 1) restriction of thoracic cage and lung development, and 2) the risk of crankshaft phenomenon (persistent anterior spinal growth in the presence of a posterior fusion, leading to recurrent and increasing spinal deformity). In extreme cases, a combined anterior and posterior fusion procedure is an option but will limit development of the thorax, lungs, and normal trunk height.

Figure 39-1. The rib-vertebral angle difference (RVAD) and rib phase. A, The rib vertebral angle is determined by a line perpendicular to the endplate of the apical vertebra and a line drawn along the center of the rib. B, Phase 1, the convex rib does not overlap the vertebral body. C, Phase 2, the convex rib overlaps the vertebral body. (From Errico TJ, Lonner BS, Moulton AW. Surgical Management of Spinal Deformities. Philadelphia: Saunders; 2009. p. 90.)

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