Current Concepts in the Management of Early-onset Idiopathic Scoliosis

Ujjwal K Debnath


Pediatr Health. 2010;4(3):343-354. 

In This Article

Abstract and Introduction


Early-onset scoliosis is a diagnosis when a child is presenting with scoliosis before the age of 5 years. This excludes other causes of scoliosis (e.g., congenital, neuromuscular or syndromic). Twin studies and observations of familial aggregation reveal significant genetic contributions to idiopathic scoliosis. Radiographic criteria help in distinguishing the progressive curves from those that will resolve spontaneously. One must do a complete clinical evaluation to exclude other organ involvement especially congenital heart disease, inguinal hernia and hip dysplasia. MRI scans of the neural axis are mandatory in curves greater than 20° at presentation to rule out any occult lesions in the CNS. Minor nonprogressive curves can be managed with observation until growth is completed. Some curves may be managed with casting and bracing. There is increased risk of morbidity and mortality due to respiratory failure in untreated children with early-onset scoliosis who have progressive curves. Therefore, progressive curves must be addressed surgically. Surgical procedures continue to evolve and are primarily directed at correcting and maintaining the curve correction while simultaneously preserving spinal and trunk growth. A definitive spinal fusion is indicated once the thoracic spinal growth is nearing completion.


Nearly 80 years ago, Harrenstein first described early-onset idiopathic scoliosis.[1] In 1951, James described at the first two types of curve patterns in structural idiopathic scoliosis.[2] In 1954, James divided idiopathic scoliosis into three types according to the age of onset: infantile (birth to 3 years), juvenile (4–9 years) and adolescent (10 years to end of growth).[3] These three periods correspond to the phases of increased growth velocity during childhood and adolescence, but it has been shown that growth velocity corresponds only to infancy and adolescence.[4] During the traditional juvenile onset period, the spinal growth decelerates and therefore juvenile-onset scoliosis is rare. It was not until recently that Dickson described the term 'early onset', which develops before the age of 5 years.[5] This is due to the fact that there is a real risk of cardiopulmonary compromise if there is a substantial thoracic deformity present before the age of 5 years.[6] In this review, early-onset scoliosis (EOS) refers to all idiopathic scoliosis of more than 10˚ spinal curvature, which develop in children below the age of 5 years.


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