What You Need To Know About Juvenile Idiopathic Scoliosis

It’s estimated that 10 to 15% of all idiopathic scoliosis cases in children are diagnosed between the ages of four and 10. These cases are referred to as juvenile idiopathic scoliosis (JIS). While most cases of JIS are mild, some can progress to more severe curvature.

It’s why JIS must be diagnosed early, so treatment can begin immediately if necessary. With that in mind, the following guide provides everything you need to know about JIS.

What Is Juvenile Scoliosis?

Scoliosis is a condition that occurs when the spine rotates and curves sideways by more than 10 degrees, causing the shoulders and hips to appear uneven. Spinal rotation may cause the ribs to protrude out to one side leading to rib humping.

Scoliosis can be caused by congenital abnormalities, neuromuscular conditions, or degenerative diseases. However, idiopathic scoliosis is a type of scoliosis where the cause is unknown, meaning doctors cannot determine the underlying cause.

When children between the ages of 4 and 10 are diagnosed with idiopathic scoliosis, it’s called juvenile scoliosis. JIS or Juvenile Idiopathic Scoliosis is slightly more common in boys than girls and usually progresses more quickly during puberty.

How JIS Differs From Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis. It typically affects children aged 10 to 18, with most cases diagnosed during puberty. AIS is also more common in girls than boys. The primary difference between

JIS and AIS is the age of the patient when they are diagnosed by the doctor. JIS is diagnosed in children aged 4 to 10, whereas AIS is diagnosed in adolescents aged 10 to 18.

Around 80% of all idiopathic scoliosis cases are diagnosed as AIS cases. However, the actual condition itself is the same. There is one additional type of idiopathic scoliosis: infantile idiopathic scoliosis (IIS), which affects children aged three or younger. IIS is the rarest form of idiopathic scoliosis and only accounts for 1% of pediatric idiopathic scoliosis cases.

Timeframe For Developing JIS

Understanding the timeframe for the development of JIS is crucial to understanding how to treat it. JIS is diagnosed during the ages when the growth of the spine slows down. Between the ages of 5 and ten, most growth occurs in the arms and legs.

Once the child hits puberty, the spine begins to grow again – and rapidly. This means that even if the child diagnosed with JIS has a mild or moderate curvature that doesn’t appear to be progressing, it can still become more severe during puberty.

Roughly 7 out of ten children diagnosed with JIS will have a curvature that worsens and requires active treatment, whereas half of the children diagnosed with IIS will improve with time and growth.

In general, the risk of progression increases during periods of rapid growth. The following are the age ranges considered “danger zones”, during which the abnormal curve of the spine is more likely to worsen:

• 0-1 years
• 11-13 years in girls
• 13-15 years in boys

Signs Of JIS

It’s important to note that symptoms don’t typically occur in JIS. Instead, the condition is discovered during a physical examination, usually during a routine checkup with the pediatrician. The following are some of the common signs that indicate the presence of JIS:

Uneven Shoulders

One of the most common signs of JIS is uneven shoulders. When the spine curves to one side, it causes one shoulder to appear higher than the other. In some cases, the difference may be subtle. In others, it may be more pronounced. Uneven shoulders generally develops during the early stages of JIS.

One Shoulder Blade Protrudes More

When the spine curves to one side, it can cause the shoulder blade on that side to protrude more than the other. This protrusion may cause clothing to fit unevenly on the child’s back or make it appear like the child has a hump. This sign more commonly appears in the later stages of JIS.

Rib Hump

The ribs may also appear more prominent on one side, called a rib hump. This issue occurs because the spine curves around the rib cage, making the ribs on the convex side of the curvature more visible. This sign is more likely to appear in the later stages of JIS.

Uneven Waistline

Another common sign of JIS is an uneven waistline. As the spine pulls on the pelvis in scoliosis, it causes unevenness in the waistline. This unevenness occurs because the hips are not level when the spine curves to one side.

Hip Height Difference

There may also be a difference in hip height. When the spine curves to one side, it can cause one hip to appear higher than the other. An uneven waistline usually accompanies a difference in hip height.

Scoliosis Red Flags To Watch Out For

It’s estimated that around 80% of all scoliosis cases are idiopathic. Idiopathic cases are often the result of rapid growth and changes in the vertebral growth plate, commonly seen during rapid puberty growth spurts.

However, this also means that around 20% of scoliosis cases have an underlying cause, such as infection, tumor, or neurological issues, that should be promptly investigated.

Underlying causes can be serious, so it’s vital to watch out for certain red flags. The following are some of the red flags that can indicate a more severe underlying cause of the scoliosis diagnosis:

Scoliosis In Pediatric Patients

If a child is diagnosed with JIS, they must be thoroughly assessed for signs of underlying pathology. If any red flags are observed, specialized imaging, such as an MRI, may be required to rule out any possible underlying conditions. Red flags may include:

• Pain at night
• Persistent and/or increasing pain
• Unexplained weight loss
• Fever or night sweats
• General malaise or constitutional upset
• Neurological disturbance
• Previous history of cancer
• Unexplained joint swelling or discoloration
• Unusual lumps or growths
• Unwarranted fatigue
• Unresponsive to treatment for more than two months

Scoliosis-Specific Red Flags

Two scoliosis-specific red flags in particular are important to assess: a left thoracic curve and a right lumbar curve. Both are rare in cases of AIS and tend to be associated with an underlying condition.

These red flags might be identified during the physical examination of the spine and, if present, further testing will be required to rule out any serious underlying pathologies. These pathologies may include Arnold-Chiari malformation, syringomyelia, tethered cord, bone lesions, disc injury, or disc disruption.

The following outlines the details of these two scoliosis-specific red flags:

The Left Thoracic Curve: A left thoracic curve curves towards the left side of the chest. This differs from most benign cases of scoliosis in adolescents, in which the spine curves right. Cases of scoliosis that curve left are often associated with pathologies such as neurological problems, and need to be carefully evaluated.

The Right Lumbar Curve: Many right lumbar curves in adolescents are caused by a problem with the vertebral growth plate. This means that the growth plate is not properly formed or growing at the same rate as the rest of the spine. This issue can result in a pelvic tilt or leg length discrepancy that can cause the spine to curve right.

Therefore, if an adolescent has a right lumbar curve that is not caused by a pelvic tilt or leg length inequality, then it is more likely to be caused by something other than growth plate disruption. As a result, additional testing will be required to rule out any potentially serious pathology.

Scoliosis With Associated Hyperkyphosis

Scoliosis and kyphosis are both conditions in which the spine curves abnormally. However, they are different from each other. Scoliosis causes the spine to curve sideways, whereas kyphosis causes the mid to upper spine to curve forward, leading to a hunched-over posture. Hyperkyphosis is a severe form of kyphosis that can cause a hunchback-like appearance.

A patient with both scoliosis and hyperkyphosis will be diagnosed as having kyphoscoliosis. Kyphoscoliosis causes the spine to curve both to the side and backward or forward simultaneously.

Most of these cases are idiopathic, however testing will be required to rule out more serious conditions that can cause kyphoscoliosis. These conditions can include neuromuscular diseases, connective tissue diseases, or degenerative diseases.

Common Causes Of JIS

There is no clear cause of JIS. The condition is idiopathic, meaning the exact cause is unknown. However, there are a few theories as to what may contribute to the development of JIS.

For example, how a child positions their body during growth spurts may play a role. Poor positioning may cause the spine to bend to one side over time as a way to compensate. As a result, the ligaments may become stretched and then tightened in the bent position, resulting in scoliosis. However, a more likely theory is that JIS is a genetic condition.

Genetic Inheritance

JIS is more likely to occur if the child has a family history of the condition. There are up to 28 different genetic defects that have been linked with scoliosis. These defects are found in the genes that control the development and growth of the bones, muscles, and ligaments.

Research has indicated that people with a combination of 14 or more of these genetic defects are 33% more likely to develop severe scoliosis.

How Diagnosis Works

Signs of JIS are generally noticed by family members or a family doctor during a routine examination. The doctor will perform a further physical examination to determine if scoliosis is present.

For instance, the doctor will have the child bend forward at their waist so that the spine becomes parallel to the floor. Doing so makes it easier for the doctor to identify abnormalities in the alignment of the spine. If the child does have JIS, a rib hump will appear, meaning that the ribs on one side will stick out slightly due to the abnormal rotation of the spine.

If the doctor identifies a rib hump or any other potential signs of an abnormal curvature in the child’s spine, they will order a standing x-ray. Before diagnosing the child with scoliosis, the doctor will analyze the x-rays to determine if the angle of the curve is 10 degrees or more.

If scoliosis is confirmed, the doctor will order additional diagnostic testing, including further x-rays and a spinal MRI, to rule out other possible spinal conditions. If no other conditions are discovered, they will diagnose the condition as JIS.

Case-By-Case Treatment Options

The doctor will prescribe treatment on a case-by-case basis. Treatment options vary based on several factors, including the severity of the spinal curvature at the time of diagnosis, the child’s age, and their skeletal maturity. Keeping this in mind, the following are some common treatment options based on the severity level:

Mild Curvatures

Spinal curvatures measuring between 10 and 25 degrees are considered mild. The doctor will likely recommend an observation approach for children with mild scoliosis. The doctor will usually schedule an appointment to examine the child between six and eight months after the diagnosis to determine if the curvature has progressed.

If it has progressed, the doctor will treat the child by prescribing specific exercises or recommending part-time bracing. Part-time bracing involves wearing a brace for several hours during the day, but not at night or during physical activity.

Moderate To Severe Curvatures

A moderate to severe curvature refers to spinal curvatures measuring over 25 degrees. If the curvature is this severe, it will likely progress unless treated immediately. In these cases, the doctor may recommend either scoliosis casting or bracing.

Scoliosis Casting

Scoliosis casting is a non-invasive procedure in which a cast (usually made from fiberglass) is placed around the torso of the child to help prevent the spinal curvature from progressing. The child will need to be put under anesthesia even though casting is non-invasive.

Anesthesia is required because the child will be placed on a traction table to manipulate the spine into the correct position for casting. This helps the orthopedic surgeon position the child’s spine and apply the cast correctly.

The cast will need to be worn 24/7 for two to six months, depending on the severity of the curvature and the child’s age. Casts are usually changed every eight weeks to correct the spinal curvature gradually.

Our clinic does not recommend scoliosis casting because serial anesthesia can lead to neurotoxic effects.

Scoliosis Bracing

Children with a spinal curvature measuring 25 degrees or more may be prescribed a custom-made brace to prevent the curvature from progressing. Doctors generally recommend bracing if the child is older or scoliosis casting has already been done.

There are different types of braces, but they all work to hold the spine in the correct position and prevent it from curving further. The type of brace a doctor recommends will depend on the severity of the curvature, the child’s age and skeletal maturity, and where the curvature is located on the spine.

For example, the ScoliBrace uses x-rays, posture analysis, and complete 3D body scans to fit the brace to the child’s individual needs. As a result, the ScoliBrace can prevent the progression of the curvature in different parts of the spine and also simultaneously reduce it.

Scoliosis-Specific Exercises

Scoliosis-specific exercises can be helpful if the curvature is between mild and moderate. Once the curvature has progressed to a more severe state, more specific treatments will be needed to reduce the curvature and prevent progression.

However, physical therapy can still be helpful when combined with bracing. The doctor or physical therapist will recommend exercises the child can do at home to strengthen their muscles and improve their comfort when wearing their brace.

Doctors often recommend Schroth therapy for children diagnosed with JIS. The Schroth method combines breathing exercises, strength-building exercises, and postural awareness to help balance the muscles and tissues in the back. Remember that the specific exercise regime prescribed to the child will be based on the child’s individual needs.

As such, the doctor may prescribe a combination of Schroth therapy and other home exercises.

Continuous Progression

Surgery may be needed if the progression of the curvature continues despite bracing or casting. The following are three common scoliosis surgeries a surgeon may recommend:

1. Spinal Fusion: Spinal fusion prevents the spine from continuing to grow crooked by connecting two or more vertebrae so they can no longer move independently. The procedure involves making an incision in the back or neck to reach the spine. A bone graft is then used to fuse together the two vertebrae. Rods, hooks, and screws are often used to straighten the spine in the correct position during healing as well, essentially functioning as an internal brace.
2. Expanding Rod: An expanding rod is a metal rod that is inserted into the spine. The doctor can use a remote to lengthen the rod every three to six months as the child grows without having to perform additional surgery. Surgically implanting an expanding rod is typically only done if the scoliosis progresses rapidly at a young age.
3. Vertebral Body Tethering: Vertebral body tethering is a newer type of surgery that is less invasive than spinal fusion. The surgeon will make small incisions through which they will place small screws along the abnormal curvature of the spine. The surgeon will then thread a cord through the screws, which can be tightened or loosened to help correct the curvature.

Chiropractic Care For Treating JIS

Chiropractic care can be very effective in improving spinal motion and reducing pain. Chiropractic programs can help improve posture and pain management, even without other types of treatment, if the curvature is mild and nonprogressive.

However, these chiropractic programs can also positively impact anyone with more moderate to severe curvatures when combined with other types of treatment, such as bracing. Chiropractic care can improve spinal flexibility during the brace treatment.

Although several chiropractic methods can be applied, Chiropractic BioPhysics (CBP) is the most effective for patients with juvenile idiopathic scoliosis. CBP is an approach that uses biomechanically-based techniques to support the realignment and correction of the spine using mirror image correction.

This technique involves overcorrecting the spine in the opposite direction of its curvature utilizing a combination of specific exercises, adjustments, and traction.

Factors To Consider When Seeking Treatment

There are several key factors to consider when seeking treatment for JIS. First, it’s crucial to consult a qualified doctor who specializes in treating scoliosis. They can properly assess the severity of the child’s condition and recommend the best course of action. With that in mind, the following are the factors that need to be considered when seeking treatment:

Spinal Curvature Severity

The severity of the spinal curvature will play a role in deciding whether or not to pursue treatment and what type of treatment to pursue.

For example, if the child’s spinal curvature is mild, then the doctor may prefer to observe the curvature over time to determine if it is progressing or not. The doctor may also prescribe physical therapy or home exercises to improve the child’s posture and back muscle strength if it doesn’t progress.

If the curvature is more severe, the doctor will likely recommend treatment to prevent it from worsening. The type of treatment recommended will depend on how severe the spinal curvature is. For example, a child with a moderate, progressing curvature may be treated with a back brace, while a child with a severe curvature may require surgery.

Age And Gender Of The Patient

The age and gender of the patient are also important factors to consider when seeking treatment for juvenile idiopathic scoliosis. The younger the child is, the easier it is to treat scoliosis. This is because the spine is more flexible, and the child is still growing, so the doctor can correct the curvature more easily. For this reason, early intervention is key when treating JIS.

Risk Of Curvature Progression

The risk of curvature progression is another vital factor when seeking treatment for juvenile idiopathic scoliosis. Some children with scoliosis have a higher risk of a worsening curvature over time. This is especially true when it comes to girls since their curvatures tend to grow larger and progress faster than boys.

Is It Possible To Stop JIS From Progressing?

In general, if a child is diagnosed with JIS, it will likely continue to progress over time. However, the level of progression will vary. There are a lot of risk factors to consider, such as the gender and age of the patient.

However, the spinal curvature can worsen quickly once the child hits puberty and becomes an adolescent, during which they will experience a growth spurt. It’s why children diagnosed with JIS should not be left untreated.

Seek The Best Scoliosis Treatment For Your Child

If you have noticed one of the signs of scoliosis in your child, you’ll want to have a doctor specializing in scoliosis evaluate your child’s spine to determine a diagnosis and the best course of action. If your child has already been diagnosed with juvenile idiopathic scoliosis, you’ll want to seek the best possible treatment available to correct the curvature and prevent progression.

Here at Square One Health in Fort Collins, CO, we specialize in diagnosing and treating scoliosis. We offer various treatment options depending on the severity of your child’s condition and age. We also provide chiropractic care and home exercises to help improve your child’s posture and back muscle strength.

Have you noticed your child has an unusual spinal curvature? Learn about the importance of early diagnosis for scoliosis.