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Published on: October 16, 2013
Respiratory function and cosmesis at maturity in infantile-onset scoliosis
C J Goldberg1, I Gillic, O Connaughton
1Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland. caroline.goldberg@ucd.ie
Insights
Infantile scoliosis treatment outcomes vary significantly. Early surgery for spinal deformity does not appear to improve prognosis or respiratory function in affected children.
Area of Science:
- Orthopedics
- Pediatric Spine Surgery
- Pulmonary Medicine
Background:
- Infantile onset spinal deformity presents unique challenges due to small patient numbers, long growth periods, and variable presentations.
- Treatment aims to preserve respiratory function and cosmetic appearance in children with scoliosis.
- Assessing long-term outcomes is difficult due to the time required for meaningful results.
Purpose of the Study:
- To assess the treatment outcomes of infantile onset, nonsyndromic, noncongenital scoliosis.
- To evaluate the efficacy of management protocols over a 30-year period.
- To determine the impact of treatment timing on spinal deformity and respiratory function.
Main Methods:
- Retrospective review of patient records, including clinical and radiographic data.
- Patient recall for pulmonary function studies (spirometry, lung volumes, gas diffusion) and surface topography.
- Analysis of treatment methods including serial casting, bracing, and surgery.
Main Results:
- Nonoperative stabilization resulted in normal cosmesis and pulmonary function (FEV1 98.7%, FVC 96.6%).
- Surgery after age 10 yielded variable cosmesis and acceptable pulmonary function (FEV1 79%, FVC 68.3%).
- Early surgery (mean age 4.1 years) led to deformity recurrence and diminished respiratory function (FEV1 41%, FVC 40.8%).
Conclusions:
- Infantile scoliosis management is complex, with risks of serious deformity and respiratory compromise.
- Current evidence does not support early surgical intervention altering the prognosis for infantile scoliosis.
- Treatment methods have evolved, but outcomes remain variable, highlighting the need for further research.
Study Design:
Retrospective review of patient records, clinical and radiographic, and patient recall for full pulmonary function studies and surface topography.
Objectives:
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.
Background Data:
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.
Materials And Methods:
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.
Results:
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%).
Conclusions:
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.
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