Infant Scoliosis and Cranial Asymmetry: Case Report with Evidence-Based Conservative Management

Clinical case report linking infant scoliosis, plagiocephaly, and cervical imbalance. Includes evidence supporting early conservative orthotic and functional care.

early scoliosis bracing newborn, McAviney 2022 scoliosis case report

Infant Scoliosis and Cranial Asymmetry: A Whole-Body Perspective on Early Developmental Imbalance

Infant Scoliosis Case Report with Evidence from Conservative Orthotic Management Literature

Infant cranial asymmetry (plagiocephaly) and early spinal curvature are often managed as separate clinical entities. Cranial orthoses (baby helmets) are widely used to correct skull shape deformation during early infancy. However, emerging clinical observations suggest that cranial asymmetry may coexist with spinal and cervical imbalance, reflecting a broader neuromuscular pattern rather than an isolated skull issue.

This is supported in published literature, where deformational plagiocephaly and reduced cervical range of motion have been observed alongside infantile scoliosis, suggesting a linked postural and developmental mechanism rather than independent conditions. Springer Nature Link

Importantly, while helmets address skull shape, they do not assess spinal alignment or movement asymmetry, which may be contributing factors in early postural development.

Clinical Case Presentation

A young couple presented with their infant following a recent diagnosis of infantile idiopathic scoliosis, identified during routine pediatric evaluation.

  • Age: Under 3 months

  • Primary concern: Visible trunk asymmetry

  • Associated observations:

    • Consistent head-turning preference to one side

    • Uneven rib prominence in supine position

    • Mild cranial flattening reported by parents

    • Occasional sleep discomfort and restlessness

The parents were concerned about progression risk and whether surgical intervention or bracing would be required in the future.

Notably, cranial orthosis had been discussed previously for head shape asymmetry, but no comprehensive spinal evaluation had been performed prior to consultation.

Clinical Assessment

A full neuromusculoskeletal evaluation was performed, including cranial, cervical, and spinal examination.

Findings:

  • Mild-to-moderate thoracic spinal curvature

  • Early rib cage asymmetry

  • Cervical restriction consistent with torticollis

  • Positional cranial asymmetry (mild plagiocephaly)

  • No neurological deficits

These findings were consistent with infantile idiopathic scoliosis with associated neuromuscular imbalance affecting both cranial positioning and spinal alignment.

Evidence from Literature

A published case report by McAviney and Brown (2022) demonstrated that infantile idiopathic scoliosis can present alongside cranial asymmetry and cervical restriction. In their case:

  • A thoracic scoliosis of 44° was identified in early infancy

  • Associated deformational plagiocephaly and cervical restriction were present

  • Treatment using a thoracolumbosacral orthosis resulted in significant curve reduction

  • At follow-up, no evidence of scoliosis remained after conservative management "Treatment of infantile idiopathic scoliosis using a novel thoracolumbosacral orthosis: a case report - Macquarie University

This supports the clinical observation that early spinal curvature, cranial asymmetry, and cervical dysfunction may coexist within the same developmental pattern, and may respond to early non-invasive intervention.

Clinical Interpretation

Although cranial orthoses can be effective in reshaping skull asymmetry, they do not address:

  • cervical movement restriction

  • trunk rotational preference

  • spinal loading imbalance

  • neuromuscular asymmetry

In infancy, skull shape is highly responsive to external pressure, but spinal alignment is influenced by movement patterns and muscle balance, which guide growth over time.

Thus, cranial asymmetry should be interpreted not only as a cranial issue, but also as a potential indicator of underlying postural asymmetry.

Management Plan

A conservative, multidisciplinary approach was initiated.

1. Parental Education and Positioning Strategy

Parents were guided on:

  • Alternating carrying positions

  • Symmetrical feeding techniques

  • Encouraging bilateral head rotation

  • Reducing prolonged positional preference

2. Gentle Manual Therapy

Infant-adapted manual therapy focused on:

  • Cervical mobility restoration

  • Thoracic spine balance

  • Reduction of muscular asymmetry

  • Supporting symmetrical movement patterns

3. Pediatric Physiotherapy Referral

Therapy included:

  • Cervical stretching and mobility work

  • Postural strengthening

  • Motor symmetry development

  • Movement variability training

4. Monitoring and Bracing Consideration

At this stage:

  • Immediate bracing was not indicated

  • Regular follow-up was scheduled

  • Progression risk was considered low-to-moderate

Evidence from orthotic management literature shows that early bracing in selected infant scoliosis cases can lead to significant curve reduction, supporting the importance of close monitoring and timely escalation when needed. "Treatment of infantile idiopathic scoliosis using a novel thoracolumbosacral orthosis: a case report - Macquarie University

Early Outcome

At early follow-up:

  • Improved cervical range of motion

  • Reduced head-turning preference

  • Improved trunk symmetry

  • Parental report of better sleep and comfort

  • Mild improvement in cranial symmetry due to improved positioning patterns

These changes suggest early functional improvement in neuromuscular control, although structural monitoring remains essential.

Discussion

This case highlights several key clinical principles:

1. Head and spine develop as one functional system

Cranial asymmetry may reflect underlying cervical and spinal movement patterns rather than isolated skull deformation.

2. Visibility bias in infant care

Cranial flattening is easily visible, while spinal imbalance often remains under-assessed due to internal anatomical location.

3. Association between plagiocephaly and scoliosis

Clinical literature has reported concurrent findings of plagiocephaly, cervical restriction, and scoliosis in infant populations, supporting a shared developmental pathway. "Treatment of infantile idiopathic scoliosis using a novel thoracolumbosacral orthosis: a case report | Journal of Medical Case Reports | Springer Nature Link

4. Importance of early conservative care

Infant spine and skull are highly responsive to growth-guided interventions, making early assessment critical for optimal outcomes.

5. Role of orthoses within broader care

Cranial helmets and spinal braces serve different purposes:

  • Helmets guide skull shape

  • Braces influence spinal alignment

    But neither replaces comprehensive neuromuscular assessment.

Conclusion

Infant cranial asymmetry and scoliosis should not be viewed in isolation. Both may represent manifestations of early neuromuscular imbalance affecting posture, movement, and growth direction.

This case, supported by published literature, demonstrates that early conservative management combined with parental education and functional rehabilitation may support improved postural development during a critical growth window.

A whole-body approach ensures that treatment addresses not only visible structural changes, but also the underlying movement patterns that shape long-term development.

Medical Disclaimer

This article is for educational purposes only and does not constitute medical advice.

Scoliosis varies significantly between individuals. Always consult a qualified healthcare professional before starting any new sport or exercise program, especially if you have scoliosis, spinal conditions, pain, or previous injuries. Participation in sports should be guided by individual assessment and professional recommendation.

The image is shared for educational purposes with patient consent. Individual outcomes vary. Structural correction does not automatically restore full respiratory function. Clinical assessment is required.

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