The type of idiopathic scoliosis that occurs between 4 and 9 years of age is called juvenile scoliosis. The time period when juvenile scoliosis occurs is characterized by a much slower growth and development of the child, and thus a much slower progression of the scoliotic curve. Juvenile scoliosis is also the rarest type of scoliosis. The fact is that boys mature skeletally later than girls, and in them juvenile scoliosis occurs a little earlier, about 5 years, while in girls it is diagnosed about 7 years.
Most often, this type of scoliosis is oriented to the right in the thoracic part, and it is oriented to the left in the lumbar part, the so-called S curve. Unlike infantile scoliosis, in juvenile scoliosis spontaneous resolution of the scoliotic curve occurs less frequently.
Newborns develop 6% of the total lung volume of an adult. At the age of 5, 30% of the total lung volume develops, and at the age of 10, 50% of the total lung volume. When the scoliotic curvature worsens, serious deformities of the chest occur, which reduces the free space for the development of the lungs. This is why there is a high probability of having problems with pulmonary and cardiorespiratory functions in cases where scoliosis develops in the juvenile and infantile period, than in cases where scoliosis develops later.
Solving this problem can be achieved by operative and non-operative approaches. Non-operative (conservative) type of treatment is observation and regular monitoring of the child, application of the brace and exercises of general strengthening and stabilization of the body. Brace primarily has the role of stabilizing the scoliotic curve. During the application of the brace, the orthotist evaluates which type of the brace would be most suitable for the child. Choosing the right type of the brace is of great importance, primarily because the ribs in young children are much more flexible than in adolescents, so an inadequate brace can cause chest deformity by pushing the ribs towards the spine and increase the rotation of the ribs. In young children, brace should focus more on three-dimensional derotation and correction of chest deformities, that is stopping the rotation of the chest if it is not large, than on reducing the size of the scoliotic curve.
The Schroth method has proven to be the most effective type of treatment for scoliosis correction, however, due to its complexity, it is very difficult to apply Schroth exercises in children under 7, but it is possible to apply the Schroth principle, which can stop or slow down further progression. When applying the Schroth method, it is always important to set a good plan and program, and thus to set a clear goal. For this age, as a very effective way of correcting scoliosis using the Schroth method, it is recommended to use the Schroth position and the Schroth principle without three-dimensional breathing. In addition to this approach, it is also necessary to apply exercises of general stabilization and general strengthening of the body through correct body positions.
The main goal of the conservative approach is to slow down or stop the progression of the deformity, thus achieving delay and, if possible, bypassing the operation. Due to possible complications, it is always good to prolong the operative method of treatment at this age. Early diagnosis is one of the most important factors on which the outcome itself depends, and also, early diagnosis of scoliosis at the very beginning of its development is the best way to prevent future complications. Regular monitoring of the child, control of the brace as well as exercises that the child does are necessary in the treatment in order to achieve the best possible results.