Early Onset Scoliosis

Early Onset Scoliosis

Early Onset Scoliosis (EOS) is a form of spinal deformity in which a child’s spine (below 10 years of age) curves sideways. Over 100,000 children in the United States are found with this condition every year. EOS is a rare form of scoliosis that occurs in children younger than 10 years old. It is a serious condition that can cause severe spinal deformities and respiratory problems if left untreated.

EOS can be caused by a variety of factors, including congenital spine malformations, neuromuscular disorders, and genetic conditions. The treatment for EOS depends on the underlying cause, severity of the curvature, and the child’s age.

Early intervention is crucial in managing EOS to prevent severe spinal deformities and other complications. Treatment options for EOS may include bracing, casting, traction, or surgery, depending on the specific case. It is important to work closely with a medical team that specializes in pediatric orthopedics to ensure the best possible outcome for the child.

Here at the Southwest Scoliosis and Spine Institute, we have a team of experts and specialists that focuses on diagnosing and treating scoliosis and other spinal deformities. We routinely conduct spinal surgery and revision surgery for children and adults.

Types of Early Onset Scoliosis (EOS)

Medical experts have identified different types of EOS. Most of the types of EOS have a specific cause that relates to different health issues. A subset of the cases of EOS are idiopathic; which means they don’t have any known cause, and are thus, identified based on the child’s age when it was diagnosed. Below are the types of early-onset scoliosis:

Congenital Scoliosis

This occurs when the bones of the spine are not formed properly during pregnancy.

Neuromuscular Scoliosis

This form of EOS can link to disorders in the brain, spinal cord, or muscular system (for instance muscular dystrophy). These disorders hinder the back muscles from holding the spine in a straight position.

Syndromic Scoliosis

This condition develops from an underlying disorder that affects many parts of the body.

Infantile Scoliosis

Infantile scoliosis is a rare form of scoliosis that occurs in infants under the age of 3 years old. It is also sometimes referred to as early-onset scoliosis (EOS), although this term is more commonly used for scoliosis that occurs before the age of 10. There is no known cause for this type of EOS, and therefore, it is labeled as Infantile Idiopathic Scoliosis.

Juvenile Idiopathic Scoliosis

Juvenile scoliosis is a type of scoliosis that occurs in children between the ages of 4 and 10 years old, typically before the onset of puberty. This type of scoliosis is different from infantile scoliosis, which occurs in children younger than 3 years old, and adolescent idiopathic scoliosis, which occurs during the adolescent growth spurt.

Pediatric Scoliosis

Pediatric scoliosis refers to any type of scoliosis that occurs in children and adolescents, typically up to the age of 18. This age group includes infants, toddlers, preschoolers, school-age children, and teenagers. Spine doctors further devide Pediatric scoliosis into different categories based on the age of onset and the cause of the spinal curvature. Early-onset scoliosis (EOS) refers to cases of scoliosis that occur before the age of 10, while adolescent idiopathic scoliosis (AIS) refers to cases that develop during the adolescent growth spurt.

Causes of EOS

Early Onset Scoliosis becomes noticeable in young children when a child has any of the following:

• Pigeon breast (a condition whereby the breastbone appears exaggerated in an outward position at birth).
• Fused ribs (a condition in which the ribs are connected).
• Syndromes like neurofibromatosis (NF).
• Spinal muscular atrophy, cerebral palsy, and other neuromuscular conditions.

Signs and Symptoms of Early Onset Scoliosis

Doctors may find it difficult to identify EOS because some children do not have severe spine curvature and may not feel the pain that hinders them from their activities. Doctors can detect early signs of this condition by examining the child’s ‘symmetry’.

Here are the commonest signs of EOS:

Visible Curvature of the Spine

One of the most obvious signs of early onset scoliosis is the visible curvature of the spine. While the degree of curvature can vary, parents may notice that their child’s spine appears to bend or curve to one side. This abnormal spinal alignment can become more noticeable when the child is standing, walking, or sitting.

Your doctor will first ask questions about your child’s health, and how certain activities affect your child.  The doctors will try to understand the amount of growth and development that remains. Our scoliosis experts and specialists will also examine the spine to see your child’s back and understand its flexibility. Our Doctors will look at the child’s back while bent forwards (Adam’s position) because this enables the doctors to visually inspect the spine and easily detect scoliosis. The doctors will also examine your child’s arms and legs to ensure that they can move normally. A low-dose x-ray will get taken to see exactly how your child’s bones are progressing. This x-ray will help your doctor understand your child’s current bone growth condition coupled with a physical exam will help him/her devise a diagnosis and treatment plan.

• How to detect: Ask the child to bend forward from the waist with arms dangling towards the feet (the Adams forward bend test). In scoliosis, one side of the ribcage or back will appear higher than the other, a telltale sign of spinal curvature.

Uneven Shoulders, Hips, or Waist

Another early indicator of scoliosis is asymmetry in the body’s alignment:

Your doctor will first ask questions about your child’s health, and how certain activities affect your child.  The doctors will try to understand the amount of growth and development that remains. Our scoliosis experts and specialists will also examine the spine to see your child’s back and understand its flexibility. Our Doctors will look at the child’s back while bent forwards (Adam’s position) because this enables the doctors to visually inspect the spine and easily detect scoliosis. The doctors will also examine your child’s arms and legs to ensure that they can move normally. A low-dose x-ray will get taken to see exactly how your child’s bones are progressing. This x-ray will help your doctor understand your child’s current bone growth condition coupled with a physical exam will help him/her devise a diagnosis and treatment plan.

• Uneven Shoulders: One shoulder may appear higher than the other, and the child may seem to lean to one side when standing or sitting.
• Uneven Hips: Similarly, one hip may appear higher or more pronounced, giving the appearance of an imbalanced posture.
• Uneven Waist: The space between the arms and the waist may differ on either side of the body, indicating an abnormal spinal alignment.

Spine Doctors can see these subtle body asymmetries by observing the child from behind while standing straight.

Rib Hump or Prominence

As scoliosis progresses, it may cause a noticeable rib hump or prominence on one side of the back. This is due to the rotation of the vertebrae, which can push the ribs outwards on one side of the body.

Your doctor will first ask questions about your child’s health, and how certain activities affect your child.  The doctors will try to understand the amount of growth and development that remains. Our scoliosis experts and specialists will also examine the spine to see your child’s back and understand its flexibility. Our Doctors will look at the child’s back while bent forwards (Adam’s position) because this enables the doctors to visually inspect the spine and easily detect scoliosis. The doctors will also examine your child’s arms and legs to ensure that they can move normally. A low-dose x-ray will get taken to see exactly how your child’s bones are progressing. This x-ray will help your doctor understand your child’s current bone growth condition coupled with a physical exam will help him/her devise a diagnosis and treatment plan.

• How to detect: The rib hump is often most noticeable when the child bends forward, particularly during the Adams forward bend test. This rotational deformity of the ribs is a hallmark of structural scoliosis and differentiates it from other spinal conditions like postural kyphosis.

Leaning to One Side

Children with early onset scoliosis may develop a habitual lean to one side, even while standing or walking. This is due to the abnormal curvature of the spine affecting balance and posture.

• Observation: Parents may notice that their child favors one side more than the other, or they may frequently stand with a noticeable lean. Over time, this can lead to muscle imbalances, further exacerbating the condition.

Differences in Arm or Leg Length

Though less common, some children with early onset scoliosis may appear to have one leg longer than the other. This is not due to an actual difference in leg length but rather a result of the spinal curvature causing pelvic tilt, which affects how the legs align.

• Observation: The child may have an uneven gait or limp due to this apparent leg length discrepancy. Careful measurement of the legs and observation of the pelvis can help clarify whether this is a symptom of scoliosis or another underlying condition.

Difficulty Breathing

In more severe cases of early onset scoliosis, especially when the curvature is in the thoracic (upper back) region, the abnormal spinal alignment can begin to affect lung development and function. This is known as thoracic insufficiency syndrome.

• Symptoms: Children may experience shortness of breath, difficulty breathing during physical activities, or recurrent respiratory infections. This occurs because the curvature and rib rotation reduce the space available for lung expansion.

  Note: This symptom is more likely to appear in moderate to severe cases of scoliosis and is a serious complication that requires immediate medical attention.

Back Pain

While scoliosis in children is often painless, some children may experience mild to moderate back pain. This is typically due to muscle fatigue from trying to maintain an upright posture or from muscle imbalances that develop due to the spinal curvature.

• When pain occurs: Pain is more likely to occur in older children with early onset scoliosis or in cases where the curvature is rapidly progressing. If a child experiences persistent or worsening pain, further evaluation is necessary to rule out other causes of back pain or more severe forms of scoliosis.

Fatigue

Children with early onset scoliosis may also exhibit signs of fatigue, particularly in the lower back. This is because the muscles around the spine have to work harder to compensate for the abnormal curvature, leading to muscle strain.

• Symptoms: The child may tire easily during activities that require standing or walking for extended periods and may prefer to sit or lie down frequently to relieve discomfort.

 

Why Does Early Onset Scoliosis Matter?

The changes in shape can make your child feel bad about themselves as they grow older. Some people feel very embarrassed about their body shape. As your child grows, the shape can change (especially during a period of sudden growth).

If the conditions get more serious, it can tamper with the mechanisms of the child’s spine thereby leading to pain or aching. In some cases, EOS can affect how the lungs develop and function (especially if the condition affects an individual in early life). If the condition does not get monitored and treated at the appropriate time, it can lead to serious lung-related issues in adulthood. This can affect the person’s daily life and can also affect the heart.

EOS that becomes detected early in life can get more severe due to the growth that the spine will undergo. Bigger spinal curves can cause most of the problems described earlier. Thus, parents should want our spine experts and specialists at the Southwest Scoliosis and Spine Institute to treat their child’s scoliosis.

How Do The Experts At Southwest Scoliosis and Spine Institute Detect Early Onset Scoliosis?

Our doctor will first ask questions about your child’s health, and how certain activities affect your child.  The doctors will try to understand the amount of growth and development that remains. Our scoliosis experts and specialists will also examine the spine to see your child’s back and understand its flexibility. Our Doctors will look at the child’s back while bent forwards (Adam’s position) because this enables the doctors to visually inspect the spine and easily detect scoliosis.

The doctors will also examine your child’s arms and legs to ensure that they can move normally. A low-dose x-ray will get taken to see exactly how your child’s bones are progressing. The diagnosis of early onset scoliosis is confirmed through a combination of physical examination, imaging studies, and possibly genetic or neurological testing. The key diagnostic tools include:

• Physical Examination: A doctor will assess the child’s posture, spine alignment, and perform the forward bend test to look for asymmetry or spinal rotation.
• X-rays: Full-spine X-rays are the most common imaging technique used to confirm scoliosis and determine the degree of curvature, measured using the Cobb angle. 
• MRI: Magnetic resonance imaging (MRI) assesses the spinal cord and detect any underlying conditions such as tethered cord, tumors, or other abnormalities that may contribute to the scoliosis.
• CT Scan: In some cases, a CT scan providesdetailed images of the vertebrae and ribcage to assess the structural abnormalities in the bones.
• Pulmonary Function Tests (PFTs): If the curvature appears severe or impacting the ribcage, doctors will order pulmonary function tests to measure lung capacity and breathing functions.

Conclusion

Early onset scoliosis can present with a wide range of signs and symptoms, from subtle body asymmetries to more severe issues like breathing difficulties. Recognizing these early indicators is crucial for early diagnosis and management, as untreated scoliosis can progress rapidly during childhood growth spurts. If you notice any of these signs in your child, it’s important to consult with a healthcare professional for an accurate diagnosis and treatment plan tailored to your child’s needs. Early detection and intervention can help prevent complications and improve outcomes for children with scoliosis.

EOS Treatment

Some children with EOS do not need treatment because their condition may not get worse or may correct itself as they grow. Others with progressive spine curvatures may require immediate treatment to prevent the chest wall from deforming while providing room for the lungs to develop normally. Children with early-onset scoliosis need medical monitoring to determine the type of treatment needed for each child.

At the Southwest Scoliosis and Spine Institute, our collaborative, family-centered treatment will give your child the care he or she needs. A team of scoliosis experts and specialists will work with you to take care of your child. While planning your child’s treatment, our experts will consider the condition of the curve, its position in the spine, your child’s stage of growth and age, and other health conditions your child has.

The following processes are involved in the treatment plan:

Observation

The doctor’s first step is to monitor your child through 6 to 9 monthly appointments. The appointment will involve examining scoliosis again and having a CT scan to measure the curve of the spine. If scoliosis remains the same whenever your child goes for an appointment, the doctor will keep monitoring the condition until your child becomes fully grown.

Exercise

Children with EOS can actively take part in sports or exercise. The child needs to remain active so that he or she can have good core muscles. Although exercise by itself does not stop scoliosis from progressing. Lots of studies are currently ongoing to prove the role exercise plays in this condition.

Bracing or Body Casting

The initial treatment that is often used for young children and babies is a plaster jacket. This is done after applying an anesthetic and it gets changed every month. We will give you all the support you need for this. Plaster jackets are a proven method of stopping a spinal curve from getting worse in children with EOS.

Doctors will suggest wearing a brace if the brace can fit the child. Braces are usually rigid and the child must wear them for 23 hours every day. Your child can wear them under his or her clothes. Patients will notice their positive effect if they are used constantly. You can take the brace off your child for bathing, sports, and at other times when it’s not proper.

Early Onset Scoliosis Surgery

Your child may need surgery if the curve in the spine gets worse. The surgery’s goal is to prevent the curve from getting worse and to ensure that the spine grows and increases in length with time. To get these results, rods are used together with implants to connect the rods to the bones of the spines.

More than one surgery may become necessary as the length of the rods will need changing to allow the spine to grow. Since the spine bones are usually small during the initial surgery, the screws and hooks that support the spine may need replacing as well.  Once the surgeon notices that the amount of growth left in the spine is minimal, your doctor may recommend a surgery to replace the rods.

Let’s Give Your Child A Bright Future

With today’s technology and medical advancements, treating your child with early-onset scoliosis can lead to a very successful life for the child.  Fortunately, new treatments can help to manage and correct the curve in the spine. Through your encouragement and support, coupled with the dedication of our scoliosis experts and specialists, we will help your child lead a happy life.

Finally, your scoliosis treatment team at the Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas is available to ensure your child’s continued health. Our patients should understand that we can fix the problem.  We specialize in children with Scoliosis and our specialists are always ready to speak with you. So, call us today at 214-556-0555 to schedule an appointment with our team.

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Scoliosis Research Society: Early Onset Scoliosis
National Institute of Health: Early Onset Scoliosis