Infantile Idiopathic Scoliosis - Spine - Orthobullets

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• the T1-L5 spinal segment grows fastest in the 1st five years of life

• neural axis abnormalities 22% of patients with curves > 20° will be affected 80% of these patients will need neurosurgical involvement thoracic insufficiency syndrome

• 4% of idiopathic scoliosis cases

• males > females

• usually left thoracic

• pulmonary function impairment associated with curves > 60° cardiopulmonary issues associated with curves > 90°

• esolving type progressive type

• valuate for cavovarus feet

• abnormal abdominal reflexes associated with the presence of a syrinx

• > 20 degrees associated with progression

• phase 1 - no rib overlap phase 2 - rib overlap with the apical vertebrae high risk for curve progression

• high risk for curve progression RVAD (rib vertebrae angle difference, Mehta angle) technique measure angle between the endplate and rib (line between midpoint of rib head and neck) RVAD = difference of 2 rib-vertebral angles findings > 20° is linked to high rate of progression < 20° is associated with spontaneous recovery

• syrinx (20% incidence)

• observation alone (most resolve spontaneously) indications Cobb angle < 30° RVAD < 20°

• bracing indications incompletely corrected curves after Mehta casting late presenting cases where the spine is still flexible

• ndications Cobb > 50 to 60 degrees failed Mehta casting or bracing

• delay until as close to skeletal maturity as possible fusion before age 10 years results in pulmonary compromise

• required every six to eight months

• permits growth of affected part of spine up to 5 cm

• most resolve spontaneously if progressive by age 5, >50% of children will have a curve > 70° Mehta predictors of progression Cobb angle > 20° RVAD > 20° phase 2 rib-vertebral relationship (rib-vertebral overlap) Prognosis progressive curves have poor outcomes and must be treated can be fatal if not treated appropriately