What Is Early Onset Scoliosis?
Early Onset Scoliosis (EOS) is defined as a spinal curvature that develops before age 10. It is distinct from the more common Adolescent Idiopathic Scoliosis — not just by age, but by the stakes involved. The thorax and lungs are still actively growing during these years.
Untreated or poorly treated EOS can result in thoracic insufficiency syndrome, where the chest is too small to support normal breathing and lung development into adulthood.
EOS is not just scoliosis in a younger child — the lungs are at stake. Treatment must protect both the spine and the chest it contains.
Who Gets EOS?
EOS has several underlying causes:
- Idiopathic: No identified cause; includes infantile (0–3 years) and juvenile (3–10 years) forms. Many infantile idiopathic cases resolve spontaneously.
- Congenital: Caused by vertebral malformation during fetal development (e.g., hemivertebra, unsegmented bar). These rarely resolve and often progress rapidly.
- Neuromuscular: Associated with cerebral palsy, SMA, muscular dystrophy, or spina bifida. These curves tend to be long, sweeping, and difficult to control with bracing alone.
- Syndromic: Associated with Marfan syndrome, Ehlers-Danlos syndrome, neurofibromatosis, and other systemic conditions.
The cause matters because it determines the rate of progression and the best treatment strategy.
Warning Signs in Young Children
EOS is often diagnosed by a paediatrician noticing an asymmetry during a routine check-up. Signs parents may observe include:
- One shoulder appearing higher than the other
- A rib hump visible when the child bends forward (Adam's forward bend test)
- Clothes fitting unevenly at the waist or shoulders
- The head appearing off-centre above the pelvis
- In congenital cases: a visible kink or angular deformity in the spine
If you notice any of these, a paediatric orthopaedic consultation is warranted — do not wait for the next routine appointment.
Treatment Options for EOS
1. Serial Casting (Mehta Casting)
For infantile idiopathic curves between 20–50°, serial plaster casts applied under general anaesthesia every 2–3 months can actively correct or prevent progression. This is especially effective in children under age 3. Some curves are completely resolved with casting alone. It requires commitment from the family — multiple hospital visits and constant cast-wearing — but can avoid surgery entirely in well-selected cases.
2. Bracing
Custom rigid braces are used for curves that have progressed beyond the casting window or in older young children. Compliance is crucial: effectiveness drops significantly below 16 hours per day of wear. Modern 3D-scanned braces are lighter, more comfortable, and better tolerated than older designs.
3. Magnetically Controlled Growing Rods (MCGR)
This is currently the most widely used growth-friendly surgical technique for EOS. Two titanium rods are implanted on either side of the spine during a single open surgical procedure. Subsequently, the rods are lengthened in our outpatient clinic every 3–6 months using an external magnet — no surgery, no anaesthesia needed for lengthening. The child continues to grow while the spine is guided and controlled. Lengthening continues until the child is ready for definitive fusion (typically around skeletal maturity).
At Central Ortho & Spine, we perform the initial MCGR implantation and all subsequent remote lengthenings. International families can often have lengthening done at a partner hospital in their home country, with annual visits to Istanbul for adjustment and assessment.
4. VEPTR (Vertical Expandable Prosthetic Titanium Rib)
Originally designed for chest wall deformities associated with rib fusions, VEPTR works by expanding the concave side of the thorax. It is particularly suited to congenital scoliosis cases where rib abnormalities contribute to the deformity. Like MCGR, it requires periodic surgical expansions (though less frequently with newer designs).
5. Shilla and Apical Control Techniques
Newer techniques such as the Shilla procedure use a short apical fusion with sliding screws at the curve ends that allow the rods to glide as the child grows, theoretically eliminating the need for lengthening procedures. These are performed at specialised centres and remain an area of ongoing research.
Long-Term Outlook
Children treated with growth-friendly techniques typically undergo definitive posterior spinal fusion once they approach skeletal maturity, usually in their mid-to-late teens. By this point, the lung and thorax development has been protected during the critical growth years. Outcomes for children treated early and consistently are significantly better than those treated late.
Consulting With Us
EOS management requires a team experienced specifically in paediatric spine surgery — it is not the same as adult scoliosis care. At Central Ortho & Spine in Istanbul, we manage complex EOS cases from across Europe and the Middle East. International families are welcome to send prior X-rays and MRI scans for a preliminary assessment. If in-person evaluation is needed, we can typically accommodate within 2 weeks of request.