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Overview

The underlying medical conditions of patients with early onset scoliosis help determine the prognosis and treatment. Some patients with neuromuscular conditions such as cerebral palsy or spina bifida have a very different prognosis and treatment than patients without other medical problems even if the scoliosis appears similar in size and shape. In this section we will discuss the broad groups of conditions associated with early onset scoliosis.

Neuromuscular Scoliosis

These are patients who develop scoliosis in association with conditions that affect their muscles or their nervous system. The nervous system can be affected centrally (in the brain or spinal cord) or peripherally. These conditions are usually associated with a higher rate of scoliosis than children without the condition. Also, the likelihood that the curves will get worse is higher and the effectiveness of non-surgical treatments such as bracing or casting are not as good. Some of the conditions that affect the muscles leading to scoliosis are muscular dystrophy, congenital myopathies, and hypotonia (generalized weak muscles). Some of the conditions that affect the central nervous system are chiari malformation, cerebral palsy, and spina bifida. Conditions that affect the peripheral nervous system include Charcot-Marie-Tooth disease and polio.

Syndromic Scoliosis

There are other conditions and syndromes that have a high risk for developing scoliosis that are not associated with muscles or nerves. Some of these conditions affect the bones such as osteogenesis imperfecta (brittle bone disease). Other conditions affect connective tissues. Examples of connective tissue disoprders that are associated with scoliosis are arthrogryposis, Ehlers-Danlos syndrome, or Marfan syndrome. Certain conditions are associated with spinal deformity but it is not exactly known how they affect the spine. These conditions include neurofibromatosis and a group of conditions called the muccopolysaccharidosis (i.e. Hurler Syndrome).

Congenital Scoliosis

Congenital scoliosis is a condition that is not technically an early onset scoliosis subset but rather its own category. This is because the age of onset is prenatal and not between 0 and 5. In this condition, one or more bones in the spine are severely malformed or missing. Spinal deformities in these patients have different treatments and prognoses based on the severity of deformation of the bone or bones, the pattern of deformity and whether the abnormal bones become more deformed as the child grows. Congenital scoliosis and congenital kyphosis cannot be corrected with bracing or casting. Bracing and casting, however, may be recommended for patients with congenital scoliosis and kyphosis as a means to delay progression allowing for growth and development prior to surgery. If the curves are large enough and/or worsening, the only treatments involve surgery. Fortunately, many of these patients never get worse and therefore never need surgery.