Scoliosis & Other Spine Disorders

Early-Onset Scoliosis (EOS)

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Early-onset scoliosis (EOS) is a curvature of the spine that develops in children before the age of 10. The curve can appear in the thoracic (chest) or lumbar (lower back) part of the spine, and may look like an “S” or “C” shape. EOS can range from mild to severe and may progress quickly as the child grows. Because EOS can affect how the lungs and chest grow, early diagnosis and treatment are important to help protect your child’s overall development and long-term health.

An Introduction to Early Onset Scoliosis for Patients and Parents

What Causes EOS?

EOS can be divided into different categories based on the underlying cause, including:

  • Congenital scoliosis - caused by an abnormality with spine development before birth
  • Neuromuscular scoliosis - caused by conditions like cerebral palsy, muscular dystrophy, and spinal muscular atrophy (SMA)
  • Syndromic scoliosis - associated with specific genetic disorders, including:
    • Bone dysplasias
    • Connective tissue disorders
      • Ehlers-Danlos syndromes (EDS)
      • Marfans syndrome
    • Neurofibromatosis
    • Prader-Willi syndrome (PWS)

If there’s no known cause, it’s called Infantile Idiopathic Scoliosis or Juvenile Idiopathic Scoliosis, based on the child’s age.

  • Infantile Idiopathic Scoliosis occurs before the age of 3 and is seen more often in boys than girls. Most cases resolve spontaneously but some may progress to more severe.
  • Juvenile Idiopathic Scoliosis is defined as scoliosis occurring at the ages of 3-9. This condition affects more girls than boys. These curves are generally at high risk for progression to a more severe form.

What Are the Symptoms?

Common signs of EOS include:

  • A visible curve in the spine
  • Rib protrusion on one side when bending forward
  • Shortness of breath or reduced stamina during activity
  • Uneven shoulders, hips, or waist

When Should My Child See a Specialist?

You should see an orthopedic specialist if you notice any symptoms. Your child’s pediatrician may raise concerns during a checkup. Because EOS can affect lung growth, early diagnosis and treatment are key.

How Is EOS Diagnosed?

Diagnosis starts with a physical exam from an orthopedic specialist to check for spinal curves. Imaging studies like X-rays, MRIs, or CT scans can provide a better understanding of the curve and help determine any underlying causes.

How Is EOS Treated?

Treatment for EOS depends on:

  • Your child’s age
  • The size and location of the curve
  • How fast the curve is progressing
  • The underlying cause.

Because young children are still growing, treatment for EOS focuses on:

  • Slowing or stopping curve progression
  • Supporting healthy lung/chest development
  • Avoiding spinal fusion if possible in very young children

Nonsurgical Options

If your child is still very young or their curve is mild, your specialist may recommend:

  • Observation and monitoring
  • Bracing to control curve progression
  • Spine casting to guide spinal growth
  • Physical therapy to support strength and posture

Surgical Options

Surgical options for EOS often use devices that allow for continued growth, such as:

  • Growing rods - These surgically implanted adjustable rods are periodically lengthened as the child grows. These include:
    • Magnetically controlled growing rods (MAGEC rods)
    • SHILLA growth guidance system
    • Traditional growing rods
    • Vertical expandable prosthetic titanium ribs (VEPTR)
  • Anterior vertebral body tethering (AVBT) - A flexible cord is implanted on one side of the spine, allowing for both correction of the curve and continued growth on the opposite, untethered side.

Spinal fusion may be considered later, once the child is older and has finished growing.

What Are the Risks for Surgery?

Like any surgical procedure, EOS surgery carries some risks, including but not limited to:

  • Implant-replated mechanical failure (rod breaking or loosening)
  • Infection
  • Need for additional surgeries
  • Nerve injury (rare)

Your child’s surgeon will help you understand the risks and benefits and choose the best option for your child’s needs.

What Does Recovery from EOS Surgery Involve?

Recovery depends on factors that include the type of surgery performed and your child’s overall health.

After surgery, your child will likely stay in the hospital for several days. Their pain will be carefully monitored and managed with medication. They will need to avoid strenuous physical activity as they recover.

How Long Does Recovery Take?

Initial recovery after surgery may take 4–6 weeks.  They are usually able to return to school and many physical activities at that time.  Full recovery and return to all sports can take several months.

Kids with growing rods will need ongoing care until they stop growing, including follow-up surgeries (or magnetic lengthenings) every few months.

What Is the Outlook for EOS?

Outcomes for children with EOS are generally very positive. Early diagnosis, regular monitoring, and treatment from an experienced pediatric orthopedics team can help correct or stabilize their condition and guide their development.