Early Onset Scoliosis: Symptoms, Treatment, Outlook
Early-onset scoliosis, also known as EOS, is an abnormal side-to-side curving of the spine that appears in children before the age of 10. The curve has to be larger than 10 degrees for it to be considered scoliosis. EOS can also mean an over-curving of the upper back, what’s known as kyphosis.
Symptoms depend on how severe the deformity is. However, EOS can cause heart and lung problems in children that may become worse during adulthood. When severe EOS is untreated, children are more likely to die early due to heart and lung problems.
The most common early signs of scoliosis are changes in posture due to over-curving of the spine, such as:
- Uneven shoulders, with one shoulder blade sticking out more than the other
- A “hump” caused by the ribs sticking out more on one side than the other
- Uneven waist or hip
- Tilting to one side while standing up straight
Sometimes early-onset scoliosis is first noticed when a doctor orders a chest x-ray for a child with pneumonia or another respiratory virus.
Doctors and school nurses commonly check for signs of scoliosis in children starting at age 10. However, this screening would not catch early-onset scoliosis. But it may identify children with adolescent idiopathic scoliosis, which occurs between age 10 and 18.
Complications of Early-Onset Scoliosis
Mild cases of scoliosis do not usually cause back pain. More severe cases, though, may cause pain. Some types of deformities in the spine can pinch the spinal cord or nerves and cause pain, numbness or weakness.
Scoliosis in children before the age of 10 can also cause heart and lung problems. This can make it hard for a child to breathe, which can also affect how they grow and develop. In severe cases, EOS may increase a child’s risk of dying early due to poor heart or lung function.
There are several types of early-onset scoliosis, each with different causes:
- Idiopathic: No apparent cause for the curve of the spine.
- Congenital: The bones of the spine (vertebrae) develop incorrectly while the child is in the womb. As a result, the misshapen vertebrae cause the spine to curve. Children with congenital EOS sometimes also have heart or kidney abnormalities.
- Neuromuscular: In children with certain nerve or muscle diseases, the muscles cannot hold the spine straight. This includes spinal muscular atrophy, spina bifida, cerebral palsy, and brain or spinal cord injuries.
- Syndromic: Certain diseases, or syndromes, are associated with scoliosis. This includes bone dysplasias, Prader-Willi, neurofibromatosis, or connective tissue disorders such as Ehlers-Danlos and Marfans.
Some children with early-onset scoliosis inherited a gene that causes scoliosis from one or both of their parents. Families affected by this may be referred to a specialist who studies these kinds of genetic mutations.
Early-onset idiopathic scoliosis is divided into two other types, based on the age at which it first appears:
- Infantile idiopathic scoliosis: 0 to 3 years
- Juvenile idiopathic scoliosis: 4 to 9 years
The main risk factors for early-onset scoliosis are:
- Deformities in the vertebrae that developed in the womb.
- Diseases that affect the nerves or muscles.
- Diseases, or syndromes, that are associated with scoliosis.
- Having one or more genes that cause scoliosis.
A pediatrician, pediatric orthopedist or spine surgeon can diagnose early-onset scoliosis with a plain x-ray of the child’s spine. This shows where and how big the curves of the spine are.
Additional testing, such as an MRI or CT scan, may be done to look for other problems or to plan the best treatment. These create more detailed images of the child’s spine.
X-rays, MRIs and CT scans all produce radiation, which can be harmful in large doses. Doctors try to limit the number of these tests that are done, especially in children. When deciding whether to use these tests, the doctor will weigh the benefits against the risk of exposure to radiation.
Not all children with early-onset scoliosis will require treatment. In many children who are under two years old and have spine curves less than 35 degrees, the scoliosis will get better without treatment.
For children who require treatment, the type of treatment will depend on how severe the scoliosis is. The goals for treatment of scoliosis in children is to allow the spine to grow straighter and longer, improve lung function and minimize other complications.
Non-surgical pediatric scoliosis treatments
- Observation. If treatment is not needed immediately, the doctor will continue to monitor the child to make sure the spinal curve is not getting worse. This may include additional x-rays or other tests.
- Back brace. Most braces are custom-made to fit the child and their curve. A scoliosis brace is usually worn by a child for 16 to 20 hours a day, but can be taken off for certain activities, such as bathing, swimming, sports and music lessons. A back brace will not get rid of scoliosis completely, but it can prevent the curve from worsening.
- Body casting. These are custom-made to fit the child’s body and spinal curve. They are made while the child is under anesthesia. Children wear the body cast all day long for 3 to 12 weeks at a time. They may also need to wear several casts one after the other as they grow. In children under three years old with a moderate curve, the body cast may completely correct the curve. In other children, the body cast may only delay the need for surgery.
Surgical pediatric scoliosis treatments
For more severe scoliosis (a curve larger than 40 degrees), surgery is usually required. Several surgical treatments for scoliosis in children are available:
- Growing rods. Two rods are attached to the vertebrae on either side of the spine above and below the curve. The rods are implanted under the skin. This helps the spine grow longer and straighter. The rods can be extended as the child grows taller. Some rods have magnets, which allow a doctor to adjust the length of the rod without the need for surgery.
- Vertical expandable prosthetic titanium ribs (VEPTR). One or more curved bars are attached to the spine or ribs above and below the curve. The bars can be extended as the child grows. This can help the spine grow longer and straighter. It can also be used to treat abnormalities of the ribs and chest that sometimes occur with scoliosis. This is beneficial for children with breathing problems caused by the scoliosis.
- Spinal fusion. During this surgery, the abnormal vertebrae are lined up and fused together. Metal implants are also inserted into the spine. This straightens the spine and adds stability. Spinal fusion is usually done after the child’s bones have stopped growing.
- Vertebral body tethering. A rope-like tether is attached to the side of the vertebrae with screws or staples. The tether is pulled taut. As the child grows, the tether causes the bones of the spine to grow straighter. This only works for children who are still growing. This is an experimental treatment that has not yet been approved by the U.S. Food and Drug Administration.
Early-onset scoliosis cannot be prevented. Also, things that are commonly blamed for scoliosis do not actually cause this condition, including carrying heavy backpacks, poor posture, being overweight or obese, or childhood sports injuries.
While the outlook for children with early-onset scoliosis has improved in recent years, they may continue to need ongoing monitoring and care into adulthood. How much depends upon the severity of their scoliosis and other health problems.
Many children who have been treated surgically with growing rods, VEPTR or other devices will also need spinal fusion once they have finished growing. This will help stabilize the spine and improve their quality of life.
Early-onset scoliosis is an abnormal side-to-side curving of the spine that first appears in children under age 10. It has several causes and varies in severity, but in severe cases can affect a child’s breathing and heart function.
Children with mild scoliosis may not require treatment. For others, both non-surgical and surgical treatments are available. Children who are treated for scoliosis may require ongoing monitoring into adulthood.