Children's Hospital Colorado

Early Onset Scoliosis (Ages 0-9)

What is early onset scoliosis (EOS)?

Early onset scoliosis is scoliosis diagnosed before the age of 10. The difference between early onset and adolescent scoliosis (ages 10-18) is that children with early onset scoliosis still have substantial growth of the chest and spine remaining. For children with early onset scoliosis, treatment focuses on both controlling the progression of spinal deformity while also allowing the spine and chest to grow.

Who gets early onset scoliosis?

Early onset scoliosis occurs equally in boys and girls. Early onset scoliosis occurs more commonly in children with neuromuscular disorders and specific underlying syndromes than the general population.

Types of scoliosis

There are several subcategories of early onset scoliosis that are commonly recognized, including:

  • Idiopathic scoliosis
  • Neuromuscular scoliosis
  • Syndromic scoliosis
  • Congenital scoliosis
  • Scoliosis associated with tumors, infection, prior surgery or trauma

Idiopathic early onset scoliosis

Idiopathic early onset scoliosis is scoliosis that occurs without an identifiable cause. It is by far the most common type of early onset scoliosis.

  • About 80 to 90% of infants with early onset scoliosis will not require treatment to stabilize their spine curvature. The curvature naturally straightens out with normal growth.
  • A small number of infants and toddlers will unfortunately have progressive idiopathic scoliosis, which means their spinal curve will continue or worsen as they grow.
  • In almost all cases, a provider will perform an MRI of the spine to confirm that there is no underlying issue causing the scoliosis.

Congenital scoliosis

Congenital scoliosis occurs when a child's vertebrae (small bones forming the spine) do not develop properly. It is usually diagnosed before the age of 10 and is a common cause of early onset scoliosis. Doctors will recommend different treatments and prognoses based on the underlying congenital malformation (abnormality) of the spine and chest for patients with spinal deformities. Fortunately, many of these patients never get worse or need surgery.

Syndromic scoliosis

Syndromic scoliosis is associated with specific underlying syndromes and genetic conditions. Examples of syndromes that can be associated with early onset scoliosis include:

Neuromuscular scoliosis

Neuromuscular scoliosis is due to conditions that primarily affect the muscular and/or nervous system.

Examples include:

Helpful resources

Children's Spine Foundation: a community dedicated to improving the quality of care and the outcome of treatment for patients and families dealing with chest wall and spine deformities.

Growing Spine Foundation: a nonprofit organization that supports medical education and scientific research to optimize the quality of life of children with early onset scoliosis.

What are the signs and symptoms of EOS?

Many children with early onset scoliosis look and function fairly normally. If the curve in the spine is mild, it can be difficult to distinguish a child with early onset scoliosis from children with no spinal deformity. The key to evaluating for a curve or curve progression is to pay close attention to body symmetry:

  • Shoulders should be level.
  • Shoulder blades should be the same height and shape.
  • Spine should run down the center of the back.
  • Head should be centered over the pelvis.
  • Hips should appear level.
  • Child should not lean to one side.
  • Child should hold head level.
  • Any creases in the skin on the back should be symmetric.

Back pain is generally not a feature of early onset scoliosis. Children with early onset scoliosis also do not typically experience neurologic symptoms such as numbness, weakness or loss of bowel or bladder control. If these symptoms do appear, contact your pediatrician immediately.

What tests are used to diagnose early onset scoliosis?

Your provider will perform X-rays of the spine to evaluate a child with early onset scoliosis. They may also order an MRI, especially in cases with suspected idiopathic early onset scoliosis to confirm there are no underlying problems with the spinal cord. Providers often recommend ultrasounds of the heart and kidneys for children with congenital scoliosis since abnormalities of these organs often occur with the congenital malformations of the spine.

How is early onset scoliosis treated?

There are a variety of different treatment options your provider may recommend based on your child's condition. These treatments include casting and bracing, halo traction, short fusions and magnetic rod treatment.

Casting and bracing

Providers are increasing their use of casting to treat early onset scoliosis. In many cases casting can offer a way of straightening your child's spine non-invasively over time. A cast is used to guide growth of the curved spine into a straight spine. For some children, casting is used as a means to prevent or delay progression of scoliosis.

A pediatric spine specialist will apply your child's cast in a procedure center or operating room. Our pediatric specialists will place your child under anesthesia but will not make an incision during the application. The cast typically needs to be changed every two to four months. The procedure is not painful and no pain medicine is needed following cast application. Children can be active and play normally while wearing spine casts.

Bracing is also used for management of early onset scoliosis. Providers often use bracing after your child's spine has been straightened with casting or as an alternative in kids who are too old for casting or families who do not want their child in a cast.

Halo gravity traction

In severe cases of early onset scoliosis, your child's doctor may recommend halo gravity traction to help reduce the curvature of your child's spine. Halo gravity traction uses a horseshoe-shaped ring that is secured to your child's skull with pins. This halo is used to straighten your child's spine by gently pulling the body. It can be used for severe early onset and severe adolescent scoliosis patients.

While it may sound like a painful treatment, most children respond very well to halo gravity traction. Many kids may have a headache for one to two days after the halo is applied and are treated with appropriate medications for pain relief. After the first couple days children generally have no pain with halo gravity traction, and many actually feel better with their spine stretched out than they did before traction was applied.

What's the procedure for applying halo gravity traction?

One of our orthopedic spine surgeons will apply the halo in an operating room. After one to two days, we will add weight using a novel spring-based system unique to Children's Colorado Spine Program.

Children are able to use a walker and a wheelchair to remain mobile while in traction (wearing the halo). Typically we will add weight in two to three pound increments until about half the child's body weight is achieved. In many cases, children can go home once they have reached their goal traction weight.

The amount of time your child will be in traction will depend on your child's unique case. Some children will move from traction to casting, spinal fusion or magnetic controlled growth rod treatment.

Short spinal fusions

Doctors may recommend a short spinal fusion for certain cases of congenital scoliosis. We typically recommend this for patients with a central area of the spine that was not formed properly, such as a single hemivertebra (malformation in the spine).

A short spinal fusion can control the spinal deformity, while permitting the bulk of the spine to grow normally. This surgery is similar to the surgery used for adolescent idiopathic scoliosis; however, it is performed over a smaller segment of the spine and uses smaller spinal screws and rods.

Magnetic controlled growth rod treatment

Magnetic controlled growth rod (MCGR) treatment is an advanced approach for treating kids with early onset scoliosis. This new technology uses a rod to lengthen your child's spine as they grow, without the emotional or physical discomfort of surgeries. This means your child would need fewer surgeries and less pain medication, and they would miss fewer school days as they grow.

What to expect when the magnetic controlled growth rod is placed

Before surgery, you will meet your child's surgeon and one of our spine nurses. They will explain more about your stay at Children's Colorado. This presurgery visit includes a tour, discussion about what it is like to be in the hospital, recovery information and the goals for discharge from the hospital.

Surgeons place the MCGR during an inpatient surgery. A pediatric anesthesiologist will help your child fall and stay asleep during the surgery. Your child will then stay in the hospital a few days following the surgery before they go home.

What to expect at your first rod expansion visit

After the initial surgery when rods are inserted into your child's back, patients and families will return to our outpatient clinic every two to four months for rod expansions.

At the rod expansion visit, your child gets into a comfortable position either on their stomach or side. Then, a pediatric spine specialist uses an external remote control to lengthen the rods from the outside of the skin. The external remote control causes the magnets in the rods to make the rods longer. Your doctor will decide how much to expand the rods on an individual basis.

Learn about 10-year-old Ryan Viano, our first patient to benefit from these new magnetically controlled rods.

The expansion is a quick outpatient visit

Rod expansion only takes a few minutes. Your child will usually watch TV or play a game on a tablet during the expansion. As the rods are expanded, your child may experience a tingling or odd feeling in their back, but most don’t describe the feeling of pain during the expansion.

After we expand your child's rods, your doctor will use ultrasound imaging to evaluate the length of the rod expansion. Then, you and your child can head home and return to normal life.

Benefits of the magnetic controlled growth rod

  • Rod expansion is done at an outpatient visit
  • The expansion only takes a few minutes
  • No pain medication is needed, recovery or missing school/work after expansions
  • Fewer X-rays

Why choose Children's Hospital Colorado for your child's early onset scoliosis?

At Children's Colorado, we have one of the largest early onset scoliosis programs in the region. Our pediatric specialists are core members of the Children's Spine Study Group and Scoliosis Research Society. We're also actively involved in cutting edge spine research and have numerous scientific publications on scoliosis.


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