Early Onset Scoliosis: Editorial Comment

Excerpt

Over the last decade, probably more than in any other condition in orthopaedics, we have witnessed almost exponential changes in treatment philosophy for early-onset scoliosis (EOS), a spine deformity of early childhood that is potentially fatal as a result of respiratory impairment associated with chest wall deformity. Defined as spinal deformity of any etiology presenting under the age of 5 years, it is now accepted that traditional orthopaedic management of this condition—spinal fusion—may produce morbidity of a severity similar to that associated with completely untreated deformity for reasons well described by the leading article, which reviews what is known about patients’ outcome from this traditional method. To put it simply, “definitive fusion” under the age of 5 years of more than five to six thoracic segments is an oxymoron and can no longer be recommended, because the spinal deformity is unlikely to be controlled, thoracic growth will be limited to less than 50% of normal, and restrictive lung disease (forced vital capacity [FVC] less than 50% predicted) will likely ensue, especially if the most proximal thoracic vertebrae (T1 and T2) are included in the fusion. …