Testing and diagnosis for infantile scoliosis

Early detection of infantile scoliosis is important for successful treatment to correct your child’s spinal curvature or stop it from progressing or worsening. Early treatment can greatly improve your child’s long-term health outlook. Your CHOP orthopedic physician will gather your child’s complete medical history, perform a physical exam, and look at the curvature of your child’s spine to test for scoliosis.

Imaging (X-rays) will take a closer look at your child’s spine to see if there are any problems with their bones and to measure what degree of curvature is present. X-rays are the primary diagnostic tool for infantile scoliosis and show the precise angles of curvature in two-dimensional pictures.

If the curve pattern of your child’s spine is not typical or if there is something unusual in the X-ray, your child’s physician may order one of the following tests to provide more information:

• EOS imaging, is a low-dose, 3D imaging system that scans your child standing up. An EOS scan shows us your child’s natural, weight-bearing posture and allows us to see how the joints interact with the rest of their musculoskeletal system, especially the spine, hips and legs. EOS uses a fraction of the radiation dose that a general X-ray uses, which is especially beneficial for patients with scoliosis that may require frequent imaging. This imaging test is typically used for patients aged 5 and older.
• Magnetic resonance imaging (MRI) uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures inside the body. An MRI does not expose your child to radiation.
• Computed tomography (CT) scan uses a combination of X-rays and computer technology to produce cross-sectional images (“slices”) of the body. CT scans are helpful in detecting ribcage problems.

How is infantile scoliosis treated?

At CHOP, we practice collaborative, family-centered care. A team of expert clinicians – including leading orthopedic physicians and surgeons, nurse practitioners, physician assistants, pediatric nurses, physical and occupational therapists, and other specialists — will partner with you in the care of your child.

Every spine condition is different, so treatment is determined on a case-by-case basis. In planning your child's individual treatment, our team of specialists will consider the severity of the curve, and the likelihood that it will get worse over time.

Non-surgical scoliosis interventions

Many infants with mild scoliosis may not need treatment and may only need regular monitoring to ensure their spinal curve doesn’t get worse. Monitoring may include regular observation and X-rays. Most mild cases of infantile scoliosis do not get worse, and many correct themselves as your child grows. If your child’s infantile scoliosis includes a larger curve – or one that is progressively getting larger – they may need treatment.

Bracing and casting 

If your child has a moderate spinal curve (between 25 and 50 degrees) or if their spinal curve worsens over time, non-surgical treatment for their infantile scoliosis may include:

Back bracing – The goal of bracing is to halt the progression of the spinal curve while your child is growing. The style or type of brace that is best for your child will be discussed with your orthopedic physician. See Figs. 1-2.

Serial body casting – In serial body casting, an orthopedic surgeon uses an elongation-derotation-flexion technique popularized by British orthopedic surgeon Min. H. Mehta, FRCS. The treatment, also known as Mehta casting, involves placing a body cast from your child’s armpits to their lower trunk while they are under anesthesia. The process is repeated every few months as your child grows. The treatment usually lasts 1-3 years. Mehta casting works best when started early – especially before your child is 18 months old. After casting, your child may transition to routine observation or bracing. See Figs. 3-4.

Surgical interventions for infantile scoliosis 

Surgery is often recommended for children with infantile spinal curves greater than 50 degrees that have progressed despite nonoperative treatment.

Your child’s orthopedic surgeon will determine which surgery is right for your child depending on your child’s age, size of their spinal curve and other health considerations. Each child is evaluated individually, and treatment is suggested based on their unique long-term health needs.

Growing rods

For children who have many years of growth remaining, a growth-friendly treatment option is preferable. In growing rod surgery, the curve in your child’s back is spanned by one or two rods next to the spine. The rods are attached above and below the curve. The growing rods help guide new spinal growth and drive your child’s spine straight.

As your child grows, they will return to CHOP regularly, often every 6 to 12 months for outpatient surgery to expand the growing rods. This approach minimizes spinal deformity, maximizes spine growth and allows continued lung development as your child grows.

Our surgeons have pioneered the use of magnetically adjustable growing rods. These rods can be adjusted in the doctor’s office without the need for surgery or general anesthesia. This technology has greatly reduced the number of surgeries growing rod patients require.

Vertical expandable prosthetic titanium ribs (VEPTR)

The vertical expandable prosthetic titanium rib (VEPTR) allows continued spine growth and enhances lung (pulmonary) function. Developed by the late Robert M. Campbell Jr., MD, once one of CHOP’s leading orthopedic surgeons, the VEPTR is the most advanced treatment option for children with thoracic insufficiency syndrome (TIS), a rare condition. 

Children with TIS have severe deformities of the chest, spine and ribs that prevent normal breathing and lung development.

VEPTR straightens the spine and expands the space available for your child’s lungs and other internal organs to grow. VEPTR devices can be attached to your child’s spine, rib, or pelvis, and multiple devices can be implanted depending on your child’s individual needs.

Like growing rods, VEPTR is surgically adjusted as your child ages and reaches full skeletal maturity.

Spinal fusion

During spinal fusion surgery, the abnormal curved spinal bones are realigned and fused together. Metal implants are also inserted to correct the curve.

Spinal fusion will stop your child’s spine from growing in the area that it is fused, which is why the procedure is generally not recommended as a first treatment for infantile scoliosis or early-onset scoliosis in younger children who are still growing.

The results of spinal fusion are much more positive if the surgery is performed once your child is at or approaching skeletal maturity. For adolescents who have achieved normal lung capacity before their scoliosis curves worsened, spinal fusion can improve their quality of life and life expectancy.

Safety in spine surgery

Surgery can dramatically improve the long-term outcomes for your child with infantile scoliosis, but it can also be a stressful experience for you and your child. At CHOP, we offer a wealth of resources that can help you and your child prepare for surgery.

Additionally, we follow many best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. Our practices have been adopted by many other children’s hospitals around the world. Some safety protocols our orthopedic surgical team uses include:

• A strict antibiotic protocol before we operate
• The use of innovative navigation and imaging equipment during surgery, like StealthStation® and O-arm® Surgical Imaging
• Continuous monitoring of your child’s anesthesia during surgery, including specialized spinal cord monitoring
• Procedures after we operate (postoperative clinical pathways) to ensure quality standards, and rapid patient recovery

To learn more, read how we make safety in surgery a top priority.

Follow-up care for infantile scoliosis 

If we recommend spine bracing for your child, we will re-evaluate them every six months until their condition is stable. If we recommend bracing treatment leading up to spine surgery, we will evaluate your child regularly before and after surgery until their condition is stable. After your child’s spine is stabilized, we recommend annual visits to an orthopedic healthcare provider.

If your child receives traditional growing rods or VEPTR treatment, we may recommend an additional surgery – such as spinal fusion – when your child has finished growing.

After treatment — whether surgical or nonsurgical — your CHOP orthopedic team will continue to follow up on your child’s care at our Philadelphia Campus or one of our CHOP Care Network locations.

We may use “EOS micro-dose” as part of your child’s follow-up care. CHOP was the first institution in the U.S. to introduce this imaging for use in scoliosis follow up care. Micro-dose imaging uses one-third of the standard EOS radiation dose, further reducing radiation exposure for children who may require frequent imaging.

We recognize that your child's pediatrician is an important part of the clinical team and will provide regular updates on your child’s progress. If they need continued care and monitoring, we will help transition your child’s care to an adult orthopedic team.

What is the outlook for babies with infantile scoliosis?

Most children with infantile scoliosis have only mild to moderate curvature, and either do not require treatment or can be effectively helped by bracing and casting.

Most children with surgically corrected scoliosis do well and lead active, healthy lives. Scoliosis surgery does not affect the ability to choose a career with high physical demands, nor does it affect their ability to have children in adulthood. When clothed, most children show no visible signs or symptoms of scoliosis five years after surgery.

Recent research shows that:

• 80% of infantile scoliosis cases, especially those diagnosed before age one with mild curves, can resolve on their own without treatment.
• For children who need care, bracing has shown success rates at about 60%, depending on how severe the curve is and how well your child wears the brace.
• Serial body casting is very effective, particularly when it is started before 18 months of age.

With early diagnosis and the right treatment, many children with infantile scoliosis can live normal, healthy lives.

Why choose CHOP’s scoliosis experts?

CHOP is consistently ranked among the best in the nation for pediatric orthopedic care, according to U.S. News & World Report. Our Spine Program is one of the largest multidisciplinary programs in the world dedicated to the diagnosis and treatment of pediatric spine conditions. We have led the development and introduction of new treatments, from innovative bracing and exercise therapy to new surgical approaches.

We provide complete evaluation and treatment to thousands of babies, children and teens with spinal deformities and other conditions affecting the spine. Every spine condition is different, so treatment is decided on a case-by-case basis. We care for children with all types of scoliosis, from mild to the most severe.

We know it’s important to explore all non-surgical options when it comes to treatment for your child’s spinal condition. That’s why we focus on non-invasive treatment options first, whenever possible, including bracing, casting and special physical therapy programs. 

When surgery is necessary, we use cutting-edge navigation and imaging equipment in our operating rooms and follow enhanced safety protocols. And in the most severe cases, where the curvature of the spine causes breathing problems or restricts your child’s lung development, our Wyss/Campbell Center for Thoracic Insufficiency Syndrome is here to help. 

Infantile scoliosis frequently asked questions

What is the prognosis for infantile idiopathic scoliosis? 

The prognosis for infantile idiopathic scoliosis is generally positive. More than half of all cases resolve on their own without treatment. For children with progressive curves, early intervention with treatments like casting can help correct your child’s spine and lead to healthy development.

What is the difference between congenital scoliosis and infantile scoliosis? 

The difference between congenital scoliosis and infantile scoliosis is the cause. Congenital scoliosis is present at birth and happens because the bones in the spine did not form correctly before birth. Infantile scoliosis develops after birth in babies younger than three years old, and what causes this type of scoliosis in babies is generally unknown (idiopathic).

Is scoliosis hereditary from mom or dad? 

Scoliosis can run in families (it is believed to have a genetic link), meaning a child may inherit a tendency to develop scoliosis from either parent. However, many cases happen without a clear family history.

At what age does scoliosis stop progressing? 

Scoliosis often progresses during periods of rapid growth, especially in children and teens between ages 10-15. This progression slows significantly after children have reached their adult size and form (skeletal maturity).