Respiratory function and cosmesis at maturity in infantile-onset scoliosis.
METHODS
Retrospective review of patient records, clinical and radiographic, and patient recall for full pulmonary function studies and surface topography.


OBJECTIVE
Assessment of outcome of treatment policy after age 15 during the previous 30 years to establish the efficacy of management protocols in a group that is too small and too varied for more formal assessment.


BACKGROUND
Spinal deformity presenting during infancy or early childhood poses a clinical problem caused by small numbers, long growth period, variable presentation and treatment methods, and, finally, the length of time that must pass before meaningful outcome results can be assessed. The aims of treatment are to preserve respiratory function and cosmetic appearance.


METHODS
The records of patients with infantile onset, nonsyndromic, and noncongenital scoliosis were reviewed. Thirty two were at least age 15 years at the time of review and 21 of these agreed to attend for full pulmonary function testing (spirometry, lung volumes, gas diffusion) and surface topography, whereas two more had recent spirometry results available in their record. Treatment had been serial casting with Risser jacket, bracing, or surgery.


RESULTS
Those whose scoliosis resolved or was stabilized by nonoperative means (N = 6) at an acceptable Cobb angle had normal cosmesis and pulmonary function (mean FEV1 = 98.7%, mean FVC = 96.6%). Those who were managed by casting or bracing and underwent surgery after age 10 (N = 6, mean age at surgery 12.9 y) had variable cosmesis and acceptable pulmonary function (mean FEV1 = 79%, mean FVC = 68.3%). Those whose deformity necessitated early surgery (N = 11, mean age at surgery 4.1 y) had recurrence of deformity and diminished respiratory function (mean FEV1= 41%, range 14%-72%, mean FVC = 40.8%, range 12%-67%).


CONCLUSIONS
Although these are small numbers and treatment methods have changed since the beginning of the series, the results indicate that this condition is not simple to treat and for some children still has the risk for serious deformity and respiratory compromise. There is, as yet, no evidence that early surgical intervention in this group of patients with infantile scoliosis has altered their prognosis in any meaningful way.
Goldberg
C J
CJ
Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland. caroline.goldberg@ucd.ie
Gillic
I
I
Connaughton
O
O
Moore
D P
DP
Fogarty
E E
EE
Canny
G J
GJ
Dowling
F E
FE
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001915:Braces; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008168:Lung / Q000503:physiopathology*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D012119:Respiration; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012600:Scoliosis / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome