The Hidden Cost of Growth-Friendly Treatment for Early Onset Scoliosis

Abstract

Surgical treatment of early onset scoliosis (EOS) presents unique challenges because of the long period of treatment and multiple surgical interventions. Current surgical techniques are successful in terms of deformity correction, but by looking at a wider perspective, one can see that there is much more to EOS than the radiographic deformity.Growth-friendly treatment with growing rods have the potential to result in a stiff thoracic cage, and treatment can result in significant deteriorations in the child and parents' psychosocial status not only during the treatment period, but even after the surgical treatment is over. The long-term effect of metal ion release and higher radiation exposure of patients with EOS is also an important consideration over the lifetime of the patient.The purpose of this review is to emphasize that EOS is not solely a musculoskeletal disorder but more of a systemic one. Surgical treatment may bring lifelong impacts on the patient's health, some being iatrogenic and others more of a disease-related nature. The non-spine outcomes of EOS treatment should not be overlooked. Key Concepts• Early onset scoliosis (EOS) is a systemic disorder.• Growth-friendly treatments are preferred to prevent cardiopulmonary disease; however, the positive effects on pulmonary development may be less than expected, and repetitive surgical interventions may result in a stiff thoracic cage.• Surgical stress brings a psychosocial burden on the patients which may persist into adulthood.• Persistently elevated levels of metal ions is a serious concern, with unclear long-term effects.• Increased radiation exposure in patients with EOS is still an issue despite the use of new techniques.