Spine Deformity 3 (2015) 107
www.spine-deformity.org
Consensus Statement
EARLY ONSET SCOLIOSIS CONSENSUS STATEMENT, SRS
GROWING SPINE COMMITTEE, 2015
David L. Skaggs, MD, MMM, Tenner Guillaume, MD,
Ron El-Hawary, MD, John Emans, MD, Michael Mendelow, MD,
John Smith, MD, the members of the SRS Growing Spine Committee
Early Onset Scoliosis (EOS) refers to spine deformity that is present before
10 years of age. EOS is further organized to reflect etiology as applicable:
Diagnostic Categories of EOS:
Idiopathic:
 Curves for which there is no apparent cause or related underlying
etiology.
B Infantile idiopathic-a subgroup of idiopathic curves which develop
in infants and children less than 3.
Congenital:
 A particular type of EOS in which the vertebrae develop incorrectly in
utero.
B Congenital scoliosis is sometimes associated with cardiac and renal
abnormalities. Evaluation may include studies of heart and kidneys.
Thoracogenic:
 A particular type of EOS that may be encountered in the following
settings:
B Multiple congenital rib fusions as seen in spondylocostal or spon-
dylothoracic dysostosis, which may have congenital vertebral
anomalies as well and may also be considered congenital scoliosis.
B Changes in the chest wall following thoracic surgery which may
function as a tether which promotes change in the shape of the
spine.
Neuromuscular:
 Scoliosis which may develop in children with neuromuscular disorders
including spinal muscular atrophy, cerebral palsy, spina bifida and brain
or spinal cord injury.
Syndromic:
 Certain syndromes, such as Marfans, Ehlers-Danlos and other connec-
tive tissue disorders, as well as neurofibromatosis, Prader-Willi, and
many bone dysplasias may be associated with EOS.
Prognosis of EOS:
 EOS, depending on the severity, may be associated with compromised
pulmonary function in childhood which may also become increasingly
problematic in adult years.
 When untreated, severe EOS may be associated with an increased risk of
early death due to pulmonary compromise.
 The term Thoracic Insufficiency Syndrome (TIS) is commonly used to
describe the potential combined spine and pulmonary problems in EOS.
TIS is defined as ‘‘the inability of the thorax to support normal respi-
ration or lung growth’’.
 Idiopathic EOS with a Cobb angle of O35 degrees is likely to progress.
http://dx.doi.org/10.1016/j.jspd.2015.01.002
 In many children !2 years old with infantile idiopathic curves !35
degrees, scoliosis may resolve without treatment.
 Prognosis will also depend on any underlying disorders or
comorbidities.
Evaluation of EOS:
 Plain X-rays are sufficient to make the diagnosis of EOS.
 MRI may be indicated for curves that are larger than 20 degrees or
progressive, or if there are signs or symptoms of neurologic problems
and in persistent or progressive infantile idiopathic scoliosis. Intra-
spinal abnormalities are commonly associated with EOS, particularly
congenital scoliosis.
 CT best helps visualize bone anatomy in congenital scoliosis, and is
often useful for surgical planning, but must be weighed against risk of
radiation to young child.
Treatment Goals in EOS:
 Minimize spinal deformity over the life of the patient.
 Maximize thoracic volume and function over the life of the patient.
 Minimize the extent of any final spinal fusion, maximize motion of
chest and spine.
 Minimize complications, procedures, hospitalizations and burden for the
family.
 Consider overall development of the child.
Treatment options in EOS may include:
 Observation:
B The behavior of the curve may be monitored via repeated exam and
radiographic evaluations at various time-points during development
to look for worsening or progression of the scoliosis. Should the
curve progress, or if the curve is larger, treatment may be
appropriate:
 Bracing or casting:
B Bracing or casting programs may help by allowing growth while
minimizing curve progression. The need for surgery may be delayed
and, in some instances such as infantile idiopathic scoliosis, surgery
may be avoided. Anesthesia is usually required for casting children.
Bracing or casting congenital scoliosis is rarely effective, but some
believe bracing or casting a compensatory curve may be helpful.
 Surgery:
B Various growth-friendly surgeries are designed to follow the prin-
ciples of EOS treatment outlined above, allowing the spine and
chest to grow while controlling spine and chest deformity. Surgery
is generally recommended if brace or cast treatment should fail to
control progression, or if curve pattern does not appear amenable to
brace or cast treatment.
B Extensive thoracic spinal fusion in the very young child is associ-
ated with pulmonary compromise, and is rarely the best option.
 Exercise:
B Manipulation, physical therapy and/or exercise has not been shown
to influence spinal deformity in EOS.