From the Guidelines
Imaging for scoliosis in an infant should include both radiographs of the complete spine and MRI of the complete spine without IV contrast, as these procedures are complementary and usually appropriate for the initial imaging of children with early onset idiopathic scoliosis. According to the American College of Radiology Appropriateness Criteria 1, this approach is recommended for children between 0 to 9 years of age. When considering imaging for scoliosis in infants, it's essential to weigh the benefits against the risks, particularly the risk of radiation exposure. However, in cases where imaging is necessary, the combination of radiographs and MRI provides a comprehensive evaluation of the spine and helps identify any underlying conditions that may be contributing to the scoliosis. Key considerations for imaging in infantile scoliosis include:
- The presence of neurological symptoms or signs
- Rapid progression of the curvature
- Unusual patterns or characteristics of the scoliosis
- Severity of the curvature, with greater than 20 degrees often prompting further evaluation
- The potential for underlying conditions such as tethered cord, syringomyelia, or congenital vertebral anomalies, which may require MRI for detection 1.
From the Research
Imaging for Scoliosis in Infants
- Imaging for scoliosis in infants is a critical aspect of diagnosis and treatment, as it helps identify the severity and type of scoliosis 2.
- The initial evaluation of scoliosis in infants typically involves radiographs, which are critical in determining the presence and severity of the curvature 2.
- However, there is a growing concern about the use of radiographic radiation in infants and children, and alternative methods such as ultrasound are being explored to reduce unnecessary radiation 3.
- Ultrasound has been shown to be a valid and reliable method for quantitative assessment of curve severity in scoliosis patients, and may be used to determine the threshold of referral that requires X-ray for children screened positive with the scoliometer and Moiré topography 3.
Diagnosis and Referral
- Infants with suspected scoliosis should be referred to a specialist if the curve is greater than 10 degrees in a patient younger than 10 years of age, is greater than 20 degrees in a patient 10 years of age or older, has atypical features or is associated with back pain or neurological abnormalities 2.
- The diagnosis and treatment of scoliosis in infants should be individualized, taking into account the patient's history, physical examination, and radiographs 2.
- A multidisciplinary approach to scoliosis management, including orthopedic doctors, physical therapists, and orthotists, is recommended to ensure optimal outcomes for infants with scoliosis 4, 5.
Treatment Options
- Treatment options for scoliosis in infants may include observation, bracing, and surgical correction, depending on the severity and type of scoliosis 2, 6.
- Physiotherapy Scoliosis Specific Exercises (PSSE) may also be used as a therapeutic intervention, either alone or in combination with bracing or surgery, to help stabilize progressive scoliosis curves and improve back asymmetry and muscle imbalance 4.