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The management of progressive infantile idiopathic scoliosis
Insights
Long-term management of infantile idiopathic scoliosis in children shows spinal fusion provides significant curve correction. However, some loss of correction can occur post-surgery due to fusion mass bending.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Scoliosis Management
Background:
- Infantile idiopathic scoliosis is a progressive spinal deformity in children.
- Early diagnosis and intervention are crucial for managing scoliosis.
- Milwaukee brace and spinal fusion are established treatment modalities.
Purpose of the Study:
- To review long-term outcomes of scoliosis management in children.
- To evaluate the effectiveness of Milwaukee brace and spinal fusion for progressive infantile idiopathic scoliosis.
- To assess correction and stability of spinal fusions over time.
Main Methods:
- Retrospective review of 27 children with progressive infantile idiopathic scoliosis.
- Analysis of treatment outcomes for single thoracic curves (Milwaukee brace followed by fusion) and double structural curves (brace-only treatment).
- Long-term follow-up to assess curve correction, fusion stability, and cosmetic outcomes.
Main Results:
- Twenty-two children with single thoracic curves achieved a mean correction of 40% after spinal fusion.
- Solid spinal fusion resulted in moderate loss of correction over several years due to fusion mass bending.
- Five children with double structural curves treated with bracing alone had less satisfactory curve control but avoided extensive fusion.
Conclusions:
- Spinal fusion is effective in correcting single thoracic curves in infantile idiopathic scoliosis.
- Long-term spinal stability after fusion can be affected by fusion mass bending.
- Brace treatment alone may be considered for double structural curves with minimal cosmetic deformity, despite less optimal curve control.
Abstract:
Twenty-seven children with progressive infantile idiopathic scoliosis have been reviewed after long-term management. Twenty-two children had single thoracic curves which were diagnosed at an early age and treated in a modified Milwaukee brace until the age of ten years when the spine was corrected and fused. The mean correction after operation was 40 per cent of the initial degree of curvature seen in early childhood before treatment. Solid spinal fusion led to a further moderate loss in correction due to bending of the fusion mass before the spine became stable several years later. Five children had double structural curves and were treated only in a brace. This provided less satisfactory control of these curves but because of the minimal cosmetic deformity, extensive spinal fusion was avoided.