Early Onset Scoliosis in Children

What you need to know about this spinal deformity in children

Early onset scoliosis (EOS) is an abnormal sideways curvature of the spine found in children under the age of 10 years.

More than 100,000 kids are diagnosed with scoliosis each year in the United States, and most have adolescent idiopathic scoliosis (AIS). AIS is the most common type of scoliosis and affects kids age 10 to 18. EOS is much rarer and often more complex in nature.

young girl with her teddy bear and coloring book

Types of Early Onset Scoliosis
Doctors have identified several types of EOS. Most forms of EOS have an obvious cause and are associated with separate health issues. On the other hand, subset of EOS cases are idiopathic, meaning they have no known cause, and are identified based on the age at diagnosis.

Below are types of EOS:

  • Congenital scoliosis occurs when the bones of the spine do not form properly in the mother’s womb.
  • Neuromuscular scoliosis is caused by brain, spinal cord, or muscular system disorders (such as muscular dystrophy). These disorders prevent the back muscles from holding the spine straight.
  • Syndromic scoliosis develops as part of an underlying syndrome or disorder that affects numerous parts of the body (such as Prader-Willi Syndrome; a rare disease affecting development).
  • Infantile idiopathic scoliosis is diagnosed in children ages birth to 3 years. It has no known cause.
  • Juvenile idiopathic scoliosis is diagnosed in children ages 4 to 10. It has no known cause.

Early Onset Scoliosis Signs and Symptoms
EOS can be hard to identify, as some children don’t have a severe spinal curve and may not have pain that prevents them from their typical activity. The main thing to keep in mind is symmetry, as it might reveal an issue when all other signs point to normal.

Below are the most common signs of EOS:

  • The body appears to lean to one side
  • Shoulders look uneven, with one shoulder blade sticking out more
  • Waistline is uneven
  • Hip height appears off balance
  • Ribs protrude on one side more

Diagnosing Early Onset Scoliosis
Your child’s pediatrician, pediatric orthopaedist, or spine specialist can diagnose EOS using a variety of methods.

Physical exam including the Adam's forward bend test (pictured below), will reveal a prominence or hump or deviation of the spine indicating a curvature. But, it’s imaging scans—namely x-ray—that doctors rely on most to confirm EOS.

Adam's forward bending test performed by a young boy

The doctor will take standing x-rays of your child’s spine to properly see the full nature of the scoliosis. Typically, one x-ray is taken from back to front (called a posterior-anterior x-ray) and the second is from the side (called lateral x-ray). Other x-rays may include bending from side-to-side.

Your doctor may also request a magnetic resonance imaging (MRI) test in order to rule out underlying involvement of the spinal cord and other structures or CT scan to show 3D views of the bone structures.

Because x-rays are used to diagnose scoliosis, and throughout the monitoring process during treatment, people have raised concerns over radiation. With this consideration in mind, doctors limit the number of x-rays that a child needs and may use lead shields to protect breast and thyroid tissue, lower dose x-rays, and even light-based scans of the body shape.

Treatment of Early Onset Scoliosis
There are four general approaches for treating EOS:

  1. Observation
  2. Spinal bracing
  3. Body casting
  4. Spine surgery

Observation
Your doctor may recommend an observation period before any active treatment is warranted, as sometimes the scoliosis will stabilize and even correct itself as your child grows particularly with very small curves in very young children. This typically means attending regular follow-up appointments with your doctor throughout the year to identify any changes in your child’s curve.

Spinal bracing
Spinal bracing is a common nonsurgical treatment for EOS. Your doctor will work with an orthotist to craft a custom spinal brace for your child. The goal of the brace is not necessarily to correct the scoliosis but to prevent the curve from progressing.

Body casting
Body casting may be recommended for children between 6 months and 6 years of age who have curves likely to progress. Body casts are custom made and placed while your child is asleep under general anesthesia. Casts can be in place for up to 12 weeks, so your child will need a series of casts during treatment. A cast may be used for more severe curves or in cases in which a brace fails to prevent the curve from getting worse. Often the cast is used to delay the need for spine surgery which is ideally performed after much of your child’s growth is complete. A brace is often used for the same purpose.

Spine surgery
If your child has a severe curve of 50-degrees or greater, spine surgery is considered but often delayed until the curvature is significantly greater and the child is bigger and has completed more growth.

There are various surgical approaches for EOS, including growing rod surgery, VEPTR® (vertical expandable prosthetic titanium rib), vertebral body tethering, growth guided devices, and spinal fusion.

A Bright Future with Early Onset Scoliosis
When your child is diagnosed with early onset scoliosis, it can be scary for both of you. Fortunately, the treatments available today are highly successful at managing or even correcting the spinal curve. Your encouragement and support—along with the dedication of your pediatric spine team—will help your child respond well to treatment, and lead a happy and full life.

Updated on: 05/08/17
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