Surgical management of early-onset scoliosis: indications and currently available techniques

Early-onset scoliosis (EOS) is a heterogeneous group of spinal deformities affecting children under the age of 10 years of which the aetiology, natural history and treatment options vary considerably. In progressive EOS, treatment is based on exhausting conservative measures (casting or bracing) to halt curve progression while allowing for continuous growth of the spine and chest development. Early spinal fusion leads to loss of longitudinal spinal growth and restriction of cardiopulmonary function. In rapidly progressive curves that have failed conservative treatment a range of ‘growth-friendly’ surgical techniques have been developed to control curve deterioration. The indications and characteristics of distraction-based or compression-based methods, growth guidance and promising new techniques are discussed according to aetiology of EOS. Definitive spinal fusion remains reserved for patients ideally towards the end of their spinal growth and for short-segment treatment in congenital scoliosis.