The Journal of Bone and Joint Surgery Conservative Treatment for Idiopathic Scoliosis

Because idiopathic scoliosis commences and may progress during the period of spinal growth, it has been subdivided according to when it begins (James 1954); thus infantile, juvenile and adolescent types are recognised (Goldstein and Waugh 1973). While a oneyear-old baby with a 60 idiopathic thoracic curve unquestionably has infantile scoliosis, classification becomes progressively more difficult the older the child; and although a 12-year-old girl with a 90 curve is an adolescent, she does not have adolescent-onset idiopathic scoliosis, as the deformity certainly started many years earlier. Furthermore, there is no clear evidence that juvenile-onset idiopathic scoliosis exists. Of James’ 134 patients with thoracic scoliosis, only I 6 were tentatively classified as ofjuvenile onset and he did not think these worth separating from the infantile group (James 1954). Such cases may well be a hangover from infancy (Mehta 1977). There is much merit therefore in considering only two categories, early-onset and lateonset (Ponseti and Friedman 1950; Figs I to 4). The prevalence rate, natural history and the consequences of untreated scoliosis, as well as the strategy for treatment and its efficacy, differ very considerably between early and late-onset types. Treatment for the more common and more benign late-onset case is more “standard” and will therefore be discussed first.