JUVENILE IDIOPATHIC SCOLIOSIS - CURVE PATTERNS AND PROGNOSIS IN 109 PATIENTS

We reviewed the medical records and radiographs of 109 consecutive pat ients who had juvenile idiopathic scoliosis. The sixty-seven girls and forty-two boys were a mean of six years and ten months old (range, th ree years and four months to nine years and eleven months old) when th e curve was recognized. One hundred and four patients had a progressiv e curve: twenty-eight had a single mid-thoracic curve with the apex us ually at the eighth thoracic vertebra (Group 1A), twenty-nine had a ma jor mid-thoracic curve with the apex usually at the eighth thoracic ve rtebra and a secondary minor lumbar curve (Group 1B), twenty-seven had a single thoracic curve with the apex usually at the ninth or tenth t horacic level (Group 2), eight had a single thoracolumbar curve with t he apex at the twelfth thoracic level (Group 3), and twelve had a majo r lumbar curve with the apex at the second or third lumbar level and a secondary minor thoracic curve (Group 4). Five patients (5 per cent) had a resolving curve. Eighty-nine of the patients who had a progressi ve curve were followed to skeletal maturity. Eighty-eight patients wer e managed with a brace. The curve progressed at a rate of 1 to 3 degre es per year before the age of ten years and 4.5 to 11 degrees per year after the age of ten years. In sixty-seven of the eighty-four patient s in Groups 1 and 2, a spinal arthrodesis was performed before the age of fifteen years (mean age, eleven years and ten months; range, nine years and three months to fourteen years and eight months), at which t ime the mean curve was 47 degrees (range, 24 to 90 degrees). Eight pat ients were not seen by us until they were fifteen years old or more, a t which time the thoracic curve was 74 to 120 degrees; a spinal arthro desis was done in seven. The curves in Groups 3 and 4 had a more benig n prognosis, and only three patients in these two groups had an arthro desis. The pattern of the final curve was not always apparent at an ea rly stage, and there was extension of the primary curve of development of secondary structural curves with progression. The chief prognostic features at an early stage was the level of the most rotated vertebra at the apex of the primary curve, and the final pattern of deformity was defined by the level of the caudad neutral vertebra in the primary thoracic curve.