Scoliosis is an abnormal, side-to-side curve of the spine. The condition is often referred to based on the age of your child when the scoliosis is diagnosed:

• Early onset scoliosis includes:
  • Congenital scoliosis – diagnosed at birth or shortly after birth
  • Infantile idiopathic scoliosis – diagnosed under age 5
  • Juvenile idiopathic scoliosis – diagnosed between ages 6 and 9
• Adolescent idiopathic scoliosis (AIS) – diagnosed at age 10 and older

In kids with scoliosis the spine does not grow straight. It curves and twists. Spinal curves typically grow in an “S” or “C” shape. They can range from mild to severe.

A spinal curve is measured in degrees.

• Mild: Less than 20 degrees
• Moderate: Between 25 degrees and 40 degrees
• Severe: More than 50 degrees

Early onset scoliosis tends to affect boys more often than girls.

It is important to identify a curve in the spine early on. If treatment is needed, it can begin as early as possible. If treatment is not needed right away, your doctor will have a record of the curve. They can watch for changes as your child grows.

We make the decision to begin treatment based on each child. As a child grows, the curve can get worse, sometimes quickly. That is why starting treatment quickly is sometimes needed. Your child may have fewer problems later when treatment is started early. A doctor may wait to start treatment if the curve is mild. Mild curves often do not need to be treated.

Causes

Scoliosis sometimes shows up in very young children when a child also has:

• Chest deformities such as pigeon breast (when the breastbone is pushed outward at birth)
• Fused ribs (the ribs are connected together)

There might be other reasons scoliosis develops at a young age. These include:

• When scoliosis develops as part of a syndrome such as neurofibromatosis (NF)
• Neuromuscular conditions, such as spinal muscular atrophy (SMA) or cerebral palsy (CP)

In many cases, the cause of early onset scoliosis is not known. When this is the case, it is called idiopathic. For that reason, you may hear the term early onset idiopathic scoliosis.

Signs and Symptoms

Symptoms of scoliosis are different from child to child. Symptoms can include a difference in any of the following:

• Shoulder height
• Head position (the head is not centered with the rest of the body)
• Hip height or position
• Shoulder blade height or position
• The way the arms hang beside the body when standing straight
• The way the sides of the back look when bending forward

Diagnosis

Early onset scoliosis is typically found during a physical exam.

When we see a patient for scoliosis in the Crawford Spine Center at Cincinnati Children’s, a team of experts will:

• Perform a full evaluation of your child
• Review your child's medical history
• Perform any tests needed to see if there are problems with the bones
• Measure the degree of curve in your child’s spine
• Order X-rays to figure out the exact angles of the curve

X-rays are the main test for early onset scoliosis. Your child’s doctor might order additional tests to gather more information. This could include MRI, ultrasound and / or CT scan.

An early diagnosis means treatments can start sooner. Starting treatment as soon as possible offers the best long-term results.

Treatment

Treatment for early onset scoliosis is based on:

• The size of your child’s spinal curve
• How severe it is
• How much longer your child will continue to grow.

The Crawford Spine Center treats every type of early onset scoliosis. We offer surgical and non-surgical approaches.

Many of the minimally invasive techniques we offer were created by our doctors using the latest technology.

The goals of treatment are to:

• Slow the curve’s progression,
• Correct the curve while allowing the spine and chest to grow to prevent related health issues
• Prevent or delay the need for surgery.

We create treatment plans specific to each child. Your child’s treatment may include any of the following:

• Monitoring (watch and wait)
• Your child will have routine X-rays
• The doctor can watch for changes in the degree of the curve
• Often done with more mild curves
• Bracing (Thoracic Lumbar Sacral Orthosis / TLSO braces)
• Controls the progress of scoliosis while a child is still growing
• Made of hard plastic
• Can be put on and taken off at home as needed
• Some can be worn up to 23 hours a day
• Others are worn overnight
• Common for mild to moderate curves
• Casting
• Controls the progress of scoliosis while a child is still growing
• Casts are worn full-time and cannot be removed
• Allows the spine and chest to grow and the lungs to develop normally
• We use Mehta casts
• Most often used in children diagnosed between ages 1-3
• Spinal fusion surgery
• Allows two or more bones in the spine (vertebrae) to grow together (fuse) into one solid bone so the spine cannot bend
• Helps the spine grow in a straighter position
• Can help with back pain
• More often used in older children and teens
• Non-fusion surgery
• Guided growth surgery / Growth guided devices
• Traditional spinal growing rods
• MAGEC (MAGnetic Expansion Control System) rods
• Spinal stapling
• Vertebral body tethering (VBT)
• Vertical expanding prosthetic titanium ribs procedure (VEPTR surgery)

Long-Term Outcomes

If early onset scoliosis is not treated, it can lead to very severe deformities. It can also cause serious respiratory (breathing) problems.

The long-term outcome depends on the degree of your child’s curve. Children with small to moderate curves tend to do well. Those with moderate curves in their lower back may have slightly more back pain. For patients with larger curves, long-term outcomes following surgery are excellent.

Children who are treated for other disorders, in addition to the spinal deformity, may need long-term care into adulthood.