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Scoliosis evolves throughout life, which is its fourth dimension. It has particular biomechanical characteristics at each stage. The first stage is new-born scoliosis. The growth is very important. These scoliosis are most often related to asymmetrical posture. Rapid growth will decrease gradually during the first year of life. Scoliosis at this age have a large thoraco-lumbar curvature. Asymmetry extends to the skull with plagiocephaly.
These are the only scoliosis for which it is possible to predict progression. The Mehta index or costo-vertebral angle is measured at the level of the horizontal vertebra at the apex of the curvature. Similarly, when the tip of the convex rib overlaps the vertebral body, scoliosis is progressive. These 2 radiological signs allow an early treatment while avoiding the over-treatment. When the prognosis is progressive, the treatment consists in the realization of a posterior plaster cast shell in corrective bending of the scoliosis.
Here is an example of progressive correction of scoliosis in 6 months. From 1 year to 3 years, the child will walk. The evolution of these scoliosis is biomechanically linked to an imperfect and immature verticality. The realization of braces is difficult. Stature growth remains significant from 10 to 5 cm per year at the age of 3 years. It is especially a fundamental period for the development of the lungs and braces must not favour a restrictive syndrome.
Plaster casts have a large front opening. Like clubfoot, the serial casting allows to gradually reduce scoliosis. The Milwaukee brace should be adapted with use of polyethylene bars and a collar without hyoid support To avoid injury to the child, in case of a fall.
