Children with early onset scoliosis present with the deformity in the first five years of life. Radiographic criteria may be helpful to distinguish between the curves that will progress from those that will spontaneously resolve. Severe cardiopulmonary problems can occur in patients with untreated progressive curves. A comprehensive evaluation should be performed to identify the true cause of the deformity, including any conditions that are commonly associated with early onset scoliosis.
Progressive curves of ≥20° may require the use of magnetic resonance imaging to assess for occult lesions of the central nervous system. Surgical treatment of spinal deformity should be considered when nonoperative measures, including bracing and casting, are not indicated or fail to arrest curve progression. Surgical methods continue to evolve and are primarily directed at obtaining and maintaining curve correction while simultaneously preserving or encouraging spinal and trunk growth.
There are three surgical options for the treatment of early onset scoliosis: spinal fusion to halt the growth of the spine entirely, hemiepiphysiodesis or temporary tethering to cause a convex arrest of growth, and the use of growing-rod instrumentation to allow spinal growth by way of distraction.
In 1954, James described the three types of idiopathic scoliosis—infantile, juvenile, and adolescent—on the basis of the age of onset: infantile denotes curves that develop at three years of age or less; juvenile, those that develop between four and nine years of age; and adolescent, those that occur between ten years of age and the time at which growth is complete1. These three periods correspond to distinct periods of growth during childhood and adolescence. The infantile and adolescent periods are marked by an increased growth velocity, whereas most of the juvenile period, in contrast, correlates with a deceleration of spinal growth. Consequently, the onset of scoliosis is relatively uncommon during …
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