Children's Hospital Colorado

Casting for Infantile Scoliosis

Orthopedics | April 25, 2017


For families

  • Scoliosis in infants and young children (infantile scoliosis) is common and often resolves without the need for treatment.
  • If your child's doctor suspects infantile scoliosis, they should have a pediatric spine specialist perform an X-ray to make a diagnosis.
  • Spine casting is the recommended treatment for most cases of infantile scoliosis that do no resolve on their own and should be done at a center with expertise in treating the condition.

For health professionals

  • Infantile scoliosis signs include differences in appearance of shoulder blades, shoulder height or rib prominence.
  • A pediatric spine specialist should perform radiographs to confirm and track the progression of infantile scoliosis and an MRI should be considered if the patient exhibits signs of a neural tube defect.
  • Spinal fusion surgery in young patients is being replaced by spinal casting at specialty centers due to the risk for respiratory compromise later in life as a result of surgery.

Background on infantile scoliosis

Infantile scoliosis is a relatively common diagnosis, but the true incidence is unknown. Most mild cases go undetected. Approximately 80-90% of identified cases resolve on their own with normal growth.

Diagnosing infantile scoliosis

Signs of infantile scoliosis include differences in shoulder blade appearance from side to side, shoulder height difference and prominent ribs on one side of the body.

Radiographs (x-rays) are recommended for children with suspected scoliosis. If your radiology site is not accustomed to doing spinal radiographs on infants, it is recommended to defer these until an evaluation is done by a pediatric spine specialist.

If there is a hairy patch or a sacral dimple that does not have a visible floor, evaluation of the spinal axis by ultrasound or MRI may be recommended to evaluate for neural tube defect. An ultrasound can be done without sedation, but generally only before the age of 3-6 months. After six months, the posterior spine elements have mineralized which distorts the ultrasound image. MRI generally requires sedation for infants, but some infants can undergo MRI without sedation if they are given a feeding and then fall asleep for the scan.

Observing infantile scoliosis

Treatment options for infantile scoliosis are typically non-surgical. In most cases, the scoliosis will resolve with normal muscular development. Until infantile scoliosis is resolved, it’s important for the orthopedic team to observe the patient and take radiographs as indicated.

Radiographs can help identify patients at risk for progression of scoliosis based on the magnitude of the scoliosis and the amount of associated chest rotation. Resolving infantile scoliosis generally has little chest rotation while progressive infantile scoliosis has a greater amount of chest rotation. This is clinically seen as more asymmetry of the rib cage. On radiographs this appears as asymmetric angulation of the ribs as they take off from the spine.

80-90% Of infantile scoliosis cases resolve spontaneously
30-40% Of patients casted for infantile scoliosis will have complete resolution of their spinal curvature
250+ Pediatric spine procedures performed each year by our program

Treatment for infantile scoliosis

For cases that fail observation or have a high risk of progression, the mainstay of treatment is serial spine casting. Casting has been used for infantile scoliosis for many decades, but was largely abandoned in the late 1990s due to enthusiasm for early surgical correction with spinal fusion. Unfortunately, children having early spinal fusion often develop significant respiratory compromise as adults. This is due to restrictive lung disease from an abnormally short trunk caused by the surgery.

x-rays show the spine before (left) and after (right) casting was performed for scoliosis
These x-rays show the spine before (left) and after (right) casting was performed for scoliosis.

Experts often suggest MRIs for children with progressive infantile scoliosis because there is a 10-15% incidence of associated spinal axis abnormalities (e.g., Chiari malformation, syrinx, spinal cord tumor, tethered spinal cord).

Spine casting is done under general anesthesia with a skilled team experienced in proper casting technique. Improper casting can be ineffective at controlling scoliosis, and in worst cases, it can cause further chest wall restriction and skin pressure sores.

In the past, casting was mainly done only for children with idiopathic scoliosis (no known cause for scoliosis). Now, more pediatric orthopedic specialists also use casting for non-idiopathic cases for children with congenital spinal malformations to delay surgery. Casting should be done only at centers like the Spine Program at Children’s Hospital Colorado with pediatric expertise in the treatment of infantile scoliosis to maximize effectiveness and minimize risks.

Refer a patient

Our Spine Program offers innovative approaches, while providing the safest and most effective treatments beginning with non-surgical options.

Contact us

Email: spine@childrenscolorado.org
Phone: 720-777-6962


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