Pediatric Orthopaedics

Early-onset scoliosis is defined as scoliosis of any cause in children younger than five years of age. Such deformities at an early age can have a deleterious effect on the development of the immature skeleton and cardiopulmonary system. The goal of treatment is to control or correct these deformities. Adultlike fusion of multiple spinal segments has been used in the past but is considered undesirable in this age group due to the permanent restrictions in growth that accompany it. Several recent developments have led to progressive improvement in the management of this condition. Like Ponseti clubfoot casting, serial casting for early-onset scoliosis, as popularized by Mehta, has shown promising results, especially when the treatment is started early. This does involve, however, motivation and casting skills on the part of the physician and “buying in” by the family. Surgical options for patients who progress despite casting or for those who are not candidates for casting include distraction-based growing rods or expansion thoracoplasty, compression-based anterior tether, or guided-growth systems. Sturm and colleagues review the recent advances in the field of early-onset scoliosis and discuss the pros and cons of all different treatment options. These current trends in management and their results are important to understand to advance toward the ultimate goal of fusionless correction of early-onset scoliosis.

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