Early-Onset Scoliosis

The Spectrum of Treatment Options for Early-Onset Scoliosis

are many treatment options in early-onset scoliosis (EOS), but all can be
lumped into 2 broad groups: nonsurgical and surgical.  The nonsurgical options include: observation,
physical therapy, bracing, and casting. Surgical options include: traditional
growing rods, MAGEC growing rods, vertebral body stapling, vertebral body
tether, Shilla growth guidance procedure and fusions (bilateral and unilateral)
+/- resection.  Often a combinations of
therapies (nonsurgical and surgical) are used simultaneously during treatment,
such as growing rods (surgical) with a brace (nonsurgical). 
has not been shown to control/modify/alter the natural history of scoliosis
based on a reasonable level of scientific evidence are: spine
manipulation, massage, electrical stimulation, accupuncture, accupressure, and inversion
general milder spinal deformities and moderate ones which are not progressing
(getting worse) the nonsurgical methods are the first-line and, commonly, the
second-line of treatment.  When the
spinal deformity becomes severe or moderate (but progressive, getting worse)
the surgical procedures become treatment options. 
will discuss each type of nonsurgical and surgical options, listed above, over
a series of blogposts.  The first
treatment which will be presented is observation.  While observation, or as some have called
“watchful waiting”, may not seem like an actual treatment option, it can be
quite helpful in EOS. 
is the most basic method of treatment, can be the most difficult one for
physicians to recommend.  Sometimes
pressure to “do something” from caregivers, family and patients makes
observation challenging.  However, rarely
is there a reason, or need, to urgently perform surgery (such as worsening muscle
weakness or walking ability, or the loss of bowel or bladder control).  Observation permits time to pass, and allows
the spine to grow, which may help to determine if the spinal deformity is
static (not changing) or getting worse.  In
the outpatient setting intermittent evaluations, with radiographs, are done anywhere
from 3 months to 2 year intervals.  The
time between evaluations depends on many factors, such as patient age, type of
deformity, underling medical diagnoses, the location of the deformity,
magnitude of the deformity and the recent history of the spine deformity progression.
other benefit of observation is it gives parents/caregivers time to obtain
information and learn about their child’s spine problem.  Though spinal deformity may be commonly seen
by the child’s pediatric orthopaedic surgeon, it is a new, and often
overwhelming, problem in which parents do not have any previous experience and are
not comfortable.  It is mportant
parents/caregivers are fully informed on all aspects of their child’s diagnosis
and treatment options.  They, along with
the physician, are the leaders of their child’s care.  In addition, parents may need to obtain a
second opinion to obtain more perspectives of their child’s spine problem and
feel comfortable with the decision-making process.
remember, observation is often a reasonable option in the treatment of EOS.  Parents/caregivers should not be “rushed”
into a decision about surgery in EOS.
blogpost: spine casting

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