Treatment strategies for early-onset scoliosis

Early-onset scoliosis (EOS) is defined as a spinal deformity occurring before the age of ten years. Untreated EOS or early spinal fusion resulting in a short spine is associated with increased mortality and cardiopulmonary compromise. EOS may progress rapidly, and therefore prompt clinical diagnosis and referral to a paediatric orthopaedic or spine unit is necessary. Casting under general anaesthesia can be effective and may prevent or delay the need for surgery in curves of less than 60°. ‘Growing’ rods (traditional or magnetically-controlled) represent the standard surgical treatment in progressive curves of 45° or greater. Children with congenital scoliosis associated with fused ribs benefit from surgery with a vertical titanium prosthetic rib. Surgery with growth-friendly instrumentation is associated with a high risk of complications.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170051

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Age at Initiation and Deformity Magnitude Influence Complication Rates of Surgical Treatment With Traditional Growing Rods in Early-Onset Scoliosis

Spine Deformity ◽

10.1016/j.jspd.2016.04.002 ◽

2016 ◽

Vol 4 (5) ◽

pp. 344-350 ◽

Cited By ~ 16

Author(s):

Vidyadhar V. Upasani ◽

Kevin C. Parvaresh ◽

Jeff B. Pawelek ◽

Patricia E. Miller ◽

George H. Thompson ◽

...

Keyword(s):

Surgical Treatment ◽

Early Onset ◽

Early Onset Scoliosis ◽

Complication Rates ◽

Growing Rods

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Traditional Growing Rods Versus Magnetically Controlled Growing Rods for the Surgical Treatment of Early-Onset Scoliosis: A Case-Matched 2-Year Study

Spine Deformity ◽

10.1016/j.jspd.2014.09.050 ◽

2014 ◽

Vol 2 (6) ◽

pp. 493-497 ◽

Cited By ~ 71

Author(s):

Behrooz A. Akbarnia ◽

Jeff B. Pawelek ◽

Kenneth M.C. Cheung ◽

Gokhan Demirkiran ◽

Hazem Elsebaie ◽

...

Keyword(s):

Surgical Treatment ◽

Early Onset ◽

Early Onset Scoliosis ◽

Growing Rods ◽

Magnetically Controlled Growing Rods

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Survey to describe variability in early onset scoliosis cast practices

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.170207 ◽

2018 ◽

Vol 12 (4) ◽

pp. 406-412 ◽

Cited By ~ 2

Author(s):

A. Grzywna ◽

A. McClung ◽

J. Sanders ◽

P. Sturm ◽

L. Karlin ◽

...

Keyword(s):

Early Onset ◽

Congenital Scoliosis ◽

Patient Characteristics ◽

Study Groups ◽

Early Onset Scoliosis ◽

Radiographic Evaluation ◽

Level Of Evidence ◽

Major Curve ◽

Radiographic Measurements ◽

Multicentre Research

Purpose To investigate paediatric orthopaedists’ cast practices for early onset scoliosis regarding patient selection, cast application, radiographic evaluation, treatment cessation and adjunctive bracing. Methods A casting survey was distributed to all paediatric orthopaedists in Children’s Spine and Growing Spine Study Groups (n = 92). Questions included physician and patient characteristics, technique, treatment, outcomes, radiographic measurements and comparison to other treatments. A total of 55 orthopaedists (60%) responded, and descriptive statistics were calculated on the subset who cast (n = 45). Results A majority of respondents use cast treatment for idiopathic and syndromic scoliosis patients, but not for neuromuscular or congenital scoliosis patients. Major curve angle ranked most important in orthopaedists’ decision to commence cast treatment, in comparison with rib-vertebra angle difference or clinical observations. The major curve angle threshold to initiate casting was a median of 30° (20° to 70°), and the minimum patient age was median ten months (3 to 24). First in-cast and out-of-cast radiographs are taken standing, supine, awake, under anesthesia and/or in traction. In all, 58% consistently cast over or under the arm, while 44% vary position by patient. Respondents were divided about the use of a brace after cast treatment: 22% do not prescribe a brace, 31% always do and 36% do in some patients. Conclusions Future multicentre research studies must standardize radiographic practices and consider age and major curve angle at cast initiation and termination, scoliosis aetiology, shoulder position and treatment duration. Practices need to be aligned or compared in these areas in order to distinguish what makes for the best cast treatment possible. Level of Evidence V, Expert opinion

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