Current Concepts in the Management of Early-Onset Idiopathic Scoliosis

Abstract

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.