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Early Onset Idiopathic Scoliosis

Dr. Gillingham is Director, Surgical Services, Naval Medical Center, San Diego, CA, and Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Fan is Resident, Orthopaedic Surgery, Naval Medical Center, San Diego. Dr. Akbarnia is Clinical Professor of Orthopaedic Surgery, University of California, San Diego, and Medical Director, San Diego Center for Spinal Disorders, La Jolla, CA.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Gillingham and Dr. Fan. Dr. Akbarnia or the departments with which he is affiliated has received royalties from DePuy Spine. Dr. Akbarnia or the departments with which he is affiliated serves as a consultant to or is an employee of DePuy Spine.

Reprint requests: Dr. Akbarnia, San Diego Center for Spinal Disorders, Suite 300, 4130 La Jolla Village Drive, La Jolla, CA 92037-1481.

Children with early onset scoliosis typically present before age 5 years. Radiographic criteria help to distinguish progressive cases from those that will spontaneously resolve. Severe cardiopulmonary problems may occur in untreated progressive cases. A comprehensive evaluation should be performed to identify commonly associated conditions, such as plagiocephaly, congenital heart disease, inguinal hernia, and hip dysplasia. For curves >20°, magnetic resonance imaging of the neural axis is indicated to rule out occult central nervous system lesions. Surgical management should be considered when nonsurgical measures, including bracing and casting, fail to arrest progression. Surgical methods continue to evolve and are primarily directed at obtaining and maintaining curve correction while simultaneously preserving spinal and trunk growth.