What is Early Onset Scoliosis?


Causes of EOS

What is early onset scoliosis?
To understand early onset scoliosis, we must first define the term scoliosis. All spines have curves. When viewed from the side, some curvature in the neck, upper trunk and lower trunk is normal. Humans need these spinal curves to help the upper body maintain proper balance and alignment over the pelvis and to cushion the brain from being jarred with each step. However, when there are abnormal side-to-side curves (when viewed from the front or back) in the spinal column, we refer to this as scoliosis.

Most people with scoliosis are first recognized in their teens. This is known as adolescent scoliosis. Early onset scoliosis is scoliosis is noticed prior to the age of 10. The reason we differentiate between early onset and adolescent scoliosis is because the children with early onset scoliosis have spines that still need to grow while most of the spinal growth in children over 10 has already occurred. Thus, the treatment for these two groups of patients will be very different. In children with early onset scoliosis, care must be taken to provide a treatment that will control the progression of deformity while also allowing the spine to grow.

There are several sub-categories of early onset scoliosis that are commonly recognized. Included are idiopathic, neuromuscular, syndromic, congenital, as well as scoliosis associated with tumors, infection, prior surgery or trauma. Congenital scoliosis is associated with the abnormal formation of the spinal vertebrae themselves. This can also include the ribs which can lead to problems with lung development. Syndromic scoliosis is associated with specific underlying syndromes and genetic conditions. Neuromuscular scoliosis is an abnormal curve associated with injury or disease of the central nervous system. Idiopathic scoliosis simply means that we do not yet understand the cause of the abnormal curvature of the spine.
Essential Anatomy
To better understand scoliosis, it is helpful to have an understanding of the basic anatomy of the spine and chest wall. The spine is divided into 4 functional regions.

· The cervical spine includes the 7 vertebrae of the neck.

· The thoracic spine includes 12 vertebrae in the upper and mid back. Each of these vertebrae also has a pair of ribs that make up the chest wall.

· In the low back is the lumbar spine which is made up of 5 very mobile vertebral bodies.

· The sacrum and coccyx are the lowest parts of the spine and are functionally part of the pelvis.

In patients with scoliosis, abnormal curves in the spine can occur in the cervical, thoracic, or lumbar spine or can include curves that span multiple regions. In general, smaller curves do not cause problems, but large curves can result in decreased room in the chest for the lungs, decreased room in the spinal canal for the nerves, or decreased room in the abdomen for organs.
Many children with early onset scoliosis look and function fairly normally. If the curves are mild, it can be very difficult to distinguish a child with early onset scoliosis from children with no spinal deformity. The key to evaluating for a curve or curve progression is to pay close attention to symmetry:
  • Shoulders should be level
  • Shoulder blades should be the same height and shape
  • Spine should run down the center of the back
  • Head should be centered over the pelvis
  • Waist should have symmetric contour
  • Hips should appear level
  • There should be no abnormal fullness in one side of the thoracic or lumbar spine on standing or when bent over at the waist
  • Child should not lean to one side
  • Child should hold head level

Back pain is generally not a significant complaint unless the curve is quite large. Likewise, numbness, weakness or loss of bowel or bladder control would not normally be expected. If these symptoms do appear, emergent evaluation in the emergency department is essential.
Why treat EOS?
We treat early onset scoliosis for a number of reasons. The curves that these children have are often very aggressive and progress rapidly without treatment. Aside from the obvious deformity and aesthetic issues, as the curves progress in magnitude, they can deform the chest wall and can eventually cause problems with development of the lungs and other end organs. This can result in failure to gain height and weight, and in severe cases can result in decreased life expectancy. As a consequence, growth sparing treatments have been developed to try to control the progression of deformity while allowing the spine to grow. Additionally, as these children reach skeletal maturity, most will need some type of definitive fusion of the spine to prevent progression into adulthood. Larger, stiffer curves that were not managed as children are very difficult to correct and are at a significantly higher risk of neurologic injury during these surgeries. By controlling the scoliosis earlier, the final curve correction is often better and almost certainly safer.

The evaluation and management of early onset scoliosis is a complex and evolving field. The care of growing spine with scoliosis is a dynamic and often unpredictable challenge. Significant advances have been made over the last decade and many more are on the horizon. As we better understand the nature of these curves, we hope to continue to make advances that will provide better outcomes for these children.


Causes of EOS