Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

Abstract

Early-onset scoliosis (EOS) is defined as curvature of the spine in children >10° with onset before age 10 years. Young children with EOS are at risk for impaired pulmonary function because of the high risk of progressive spinal deformity and thoracic constraints during a critical time of lung development. The treatment of EOS is very challenging because the population is inhomogeneous, often medically complex, and often needs multiple surgeries. In the past, early spinal fusion was performed in children with severe progressive EOS, which corrected scoliosis but limited spine and thoracic growth and resulted in poor pulmonary outcomes. The current goal in treatment of EOS is to maximize growth of the spine and thorax by controlling the spinal deformity, with the aim of promoting normal lung development and pulmonary function. Bracing and casting may improve on the natural history of progression of spinal deformity and are often used to delay surgical intervention or in some cases obviate surgery. Recent advances in surgical implants and techniques have led to the development of growth-friendly implants, which have replaced early spine fusion as the surgical treatment of choice. Treatment with growth-friendly implants usually requires multiple surgeries and is associated with frequent complications. However, growth-friendly spine surgery has been shown to correct spinal deformity while allowing growth of the spine and subsequently lung growth.

An Overview of the Current State of Pediatric Scoliosis Management

“…In males, height growth surges at a mean age of 11 years and reaches a PHV of about 9.5 cm/year at the mean age of 13.5 years [53]. EOS (except small curve infantile idiopathic types) has therefore traditionally a worse prognosis, since patients have to go through most of the remaining growth [56]. Progression of congenital curves depends largely on the specific type of defect, but even with stable vertebral defects at skeletal maturity, deterioration of secondary or tertiary curves may lead to considerable increased deformity later in life [58].…”

Trunk Growth in Early-Onset Idiopathic Scoliosis Measured With Biplanar Radiography

“…According to the Scoliosis Research Society, early-onset idiopathic scoliosis (EOIS) is a three-dimensional deformity of the spine that starts before 10 years of age. Severe deformities can affect growth of the rib cage and lead to a decrease in pulmonary volume and to the development of a restrictive respiratory syndrome [1,2].…”

Mothers’ experience of caring for a child with early onset scoliosis: A qualitative descriptive study

“…Pulmonary, cardiovascular and neurological comorbidities are common and in some children there is a 50% higher risk of premature death before the age of 40, with cases as young as 16 years of age being observed (Cheung, Samartzis, & Cheung, ; Pehrsson, Larsson, Oden, & Nachemson, ). The true prevalence of EOS is unknown; however Yang, Andras, Redding, and Skaggs () reported that idiopathic EOS accounted for less than 1% of all scoliosis cases. Indeed, parenting a child with EOS is complex with potential for higher parental burden compared to that of parents of children with asthma, epilepsy, heart disease or cancer (Corona, Matsumoto, Roye, & Vitale, ).…”