Extract
Idiopathic scoliosis is a structural, lateral curvature of the spine of
unknown etiology that can occur in otherwise normal children and adolescents.
It is a condition that is affected by growth during the first two decades of
life. Harrenstein, in
19361, coined the
term infantile idiopathic scoliosis. He related it to rickets, stating that
the curve responded well to bracing. In 1951,
James2, in his
preliminary report on infantile idiopathic scoliosis, described the cases of
thirty-three infants who were three years of age or less and had a structural
left thoracic curve with no apparent etiology. Most of the infants were boys.
The scoliosis in these infants occasionally resolved, but when it did progress
it tended to progress to a very serious deformity. Later, in 1954, he
classified idiopathic scoliosis into three groups on the basis of age of
onset: infantile scoliosis with onset up to three years of age, juvenile
scoliosis with onset from four to eight years of age, and adolescent scoliosis
from ten years of age until the end of growth, with no reference to the ages
between eight and ten
years3. This
classification was eventually related to prognosis and outcome, and was soon
integrated with the previously described classification of Ponseti and
Friedman, defining different curve patterns according to the location of the
apical vertebra4.
According to James, the earlier the onset, the worse would be the final
curvature and, hence, the
prognosis3. The
accuracy of his observation is well recognized in clinical practice and in the
literature, as infantile and juvenile progressive curves are among the most
challenging problems in spinal deformity care and have possible implications
for the development of pulmonary parenchyma and, secondarily, a decreased life
span5.