Acıbadem Comprehensive Spine Center
SPINAL DISORDERS EARLY ONSET SCOLIOSIS

Scoliosis

Early Onset Scoliosis

Scoliosis with onset at small ages, especially before age 10, has different characteristics compared to scoliosis in older children. Early onset scoliosis is generally progressive. The most important factor which determines the progression of scoliosis is the speed at which the child's body develops.

What are the causes of early onset scoliosis?

Early onset scoliosis may be infantile (0-3 years) or juvenile (3-10 years) scoliosis. Both of these are types of scoliosis with unknown causes (idiopathic). The symptoms of congenital scoliosis start at an early age. Congenital scoliosis progresses very rapidly. Early scoliosis can also occur in some syndromic patients. Other causes are nerve and muscle diseases (neuromuscular), metabolic diseases (mucopolysaccharidosis etc.) and connective tissue diseases (osteogenesis imperfecta etc.).

What are the symptoms of early onset scoliosis?

- Curve to the side, abnormal gibbosity or abnormal concave curve.
- Skin anomalies on the back: increased hair growth, dimples, discoloration.
- Abnormal arms or legs.
- Unequal shoulders, waist or hips.
- Disproportionately short body compared to the legs.
- Balance disorders.
- Humps of the back which are noticeable when leaning forwards.

Why is early onset scoliosis so important?

Two significant problems can be caused by early onset scoliosis.The most important factor which determines the progression of scoliosis is the physical development of the child. scoliosis generally progresses at the same rate as the child’s growth. Treating this type of spinal curve with a brace, which is another treatment method, can be extremely difficult. Therefore, the requirement for an operation is greater in children compared to adolescents.

The second difference is the negative effects of a fusion during childhood, which results in arrest of growth and movement of the spine. The fusion procedure, which is carried out in a scoliosis operation during childhood, aims to stop the growth of the spine. This operation may cause the spinal canal to remain narrow when performed in children under age five, may disrupt lung development when performed under age 8, and may disrupt thoracic cage development when performed under age 10. Inadeqaute growth of the chest may lead to lung and respiratory problems. Finally, fusions carried out on children under the age of ten can also cause the torso to remain short.

A fusion carried out during puberty does not cause any of these potential problems because the spinal canal, the lungs and the chest are sufficiently developed and the growth phase is almost complete.

When early onset scoliosis is left untreated, what possible health problems can occur in the future?

1- Lung and respiratory problems.
2- Heart problems.
3- Loss of abilities.
4- Pressure on the spinal cord and paralysis, rarely and in very severe deformities.
5 - Severe cosmetic and psychological problems.

What is the treatment process for early onset scoliosis?

The treatment options for scoliosis which occurs during childhood can be summarised in three categories:

1- Observation
2- Brace treatment
3- scoliosis operation

The selected treatment option depends on the type of scoliosis.

Scoliosis and observation

If the spinal curve (scoliosis) is less than 20 degrees, it is observed under medical supervision.

Scoliosis and brace treatment

If the scoliosis is above 20 degrees, small children can undergo brace treatment as in older children. However, applying a brace to very small children (0-5 years) is difficult, therefore body correction casts applied under general anaesthesia may be preferred for correction.

It may not be possible to treat older children who have spinal curves greater than 40 degrees. This is somewhat different for young children.

It is possible to treat young children with curves of up to 60 degrees with a brace.

The aim of this is to slow the progression of the spinal curve. A scoliosis operation is preferred for curves above 60 degrees.

The final surgical treatment for scoliosis is "fusion", which stops the growth of the spine. The "fusion" procedure which is defined as fixation of the spine, elimination of movement and stopping growth, is not recommended in still growing children to avoid a short spine.

What is the "growing rods system" in scoliosis operations?

If treatment with a brace fails to stop the curve in children, an attempt can be made to correct the curve using screws and rods placed on the spine and without a fusion. This treatment method is known as the "growing rods system".

The spine will continue to grow. In order to avoid any negative effects, an attempt is made to correct the curve caused by growth by regular (every six months) scoliosis operations in which the rods are expanded.

The treatment method known as the "growing rods system" should be carried out until the end of puberty. A fusion then can be carried out when the growth phase decreases or ends.

What are the conditions in which fusion can be used for the surgical treatment of early onset scoliosis ?

The growing rods system used for the treatment of scoliosis in growing children may not be appropriate or successful in all cases. Delaying fusion in patients in whom this treatment has failed and allowing the curve to progress may have catastrophic consequences. In this case, a short and straight spine is preferred over a short and curved spine, and a fusion performed inevitably in the early period.

In some other conditions (e.g. in the case of congenital scoliosis and hemivertebrae) where scoliosis can be completely corrected by fusion of a very short segment of the spine, short fusion is used instead of long and cumbersome rods. Since fusion is only carried out in a limited area in this case, it is possible that the growth of the spine and the thoracic cage are not seriously affected. In some exceptional cases, a "hybrid" method is used in which a short segment fusion is combined with growing rods.

In conclusion, early diagnosis in early onset scoliosis is important and surgery is often necessary. Early surgical intervention often involves the use of methods which allows continued growth. It is difficult and laborious to treat children who are growing, but it is mostly successful in cases which are diagnosed early.

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