This section discusses juvenile early-onset scoliosis, which is considered to occur in individuals between the ages of 3 and 10.
Juvenile idiopathic scoliosis has many features that make it unique. The incidence of juvenile scoliosis is roughly equal between the ages of 3 and 6, and then starts to be seen more often in females after that, much like adolescent idiopathic scoliosis. It is distinct from both infantile and adolescent scoliosis, in that not as many cases resolve spontaneously as with infantile, and cases of juvenile early-onset scoliosis tend to have a greater chance of progressing compared to adolescent cases. Scoliosis tends to worsen during periods of growth, so the more growing an individual has left to do, the greater the risk of progression. Due to this increased risk of progression over the long-term, cases of scoliosis in a child under the age of 10 should be taken very seriously.
Bracing may be less effective in juveniles than adolescents; most studies on bracing focus on children over the age of 9. A study in 2014 appeared to show that bracing was effective in preventing Cobb angle progression and reducing the incidence of surgery. However, the recommended brace wearing time to achieve this result was significant; 18 to 22 hours every day for an average of eight years.
Surgery is typically not recommended for juvenile idiopathic scoliosis; the tendency is to wait until age 13 or 14, once the patient has finished going through their growth spurt, to reduce the chance that a repeat operation will be necessary. There are some new surgeries, such as vertebral body stapling and “growing rods” that have recently been introduced; consult with an orthopedic specialist for more information about these new approaches.
The CLEAR protocols appear to work well with case of juvenile scoliosis, although no scientific studies have been performed on this specific population yet. The most important thing to remember when a loved one has a case of juvenile scoliosis is that it will be a long process, and something that will require a long-term commitment if avoiding surgery is the goal. The best thing to do is to help your son or daughter establish a dedicated routine, and to develop the willpower to see it through. Encouragement and rewards may be necessary to ensure continued motivation, as it can sometimes be difficult for a child of this age to understand how their life and spine could be affected by scoliosis ten years down the road, if they do not follow through and maintain good compliance. Remember to stay focused upon the end goal, and celebrate the small victories along the way!