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Early onset Scoliosis

Updated : February 22, 2024





Background

Young children are affected by early-onset scoliosis, a condition which poses a unique and demanding treatment protocol.

In general, scoliosis diagnosed before 10 years of age has a significantly more complicated presentation than scoliosis diagnosed in adolescents, and it’s much harder to treat.

During this period, the patient’s thorax and spine are still developing, but lung growth must remain the primary focus.

Epidemiology

EOS is a condition which occurs in children before the age of 10, and it is responsible for 10% of all scoliosis cases in paediatric patients.

Anatomy

Pathophysiology

There are 4 types of early-onset scoliosis:

Syndromic scoliosis: It’s linked with neurofibromatosis, and defects in the vertebrae, anal atresia, cardiaological system, and renal abnormalities, limb defects, and tracheoesophageal fistula.

Neuromuscular Scoliosis: Neuromuscular disorders like muscular dystrophy or cerebral palsy contribute heavily to this condition.

Congenital Scoliosis: Caused due to a congenital disability in the segmentation and formation of vertebrae.

Structural scoliosis: Caused due to structural issues such as chest wall defects, diaphragmatic hernia, and fused ribs.

Etiology

Juvenile scoliosis affects patients aged between 3-10, and infantile scoliosis affects patients younger than 3 years old. A heterogeneous spectrum of causes are responsible for EOS.

These include idiopathic scoliosis, neuromuscular scoliosis, structural scoliosis, congenital scoliosis, and syndromic scoliosis.

Genetics

Prognostic Factors

EOS is a combination of several disorders. At the moment of presentation, deformities and co-morbidities strongly influence the prognosis. This is attributed to the syndromic aspect of the presentation, or to the influence of the curve on thoracic function and growth.

In infants, there is significant lung development in the first 2 years of life, and their alveoli mature by the age of 8. However, in those with restricted thoracic function because of the development of scoliosis may have complications such as abnormal ventilation, decreased lung tolerance, and alveolar hypoplasia.

The prognosis of EOS is greatly influenced by the patient’s skeletal maturity and the severity of the deformity. The thoracic to sacral spine grows roughly 2 centimetres per year during the first five years, 1 centimetre each year from ages 5-10, and 1.8 centimetres every year until adulthood.

The first five years, followed by adolescence, are marked by rapid growth. Individuals aged over 40 with untreated Early-onset scoliosis have 50% higher chance of mortality. And individuals with a rib-vertebral angle over 70 degrees also have an equally higher chance of mortality.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK519498/

Early onset Scoliosis

Updated : February 22, 2024




Young children are affected by early-onset scoliosis, a condition which poses a unique and demanding treatment protocol.

In general, scoliosis diagnosed before 10 years of age has a significantly more complicated presentation than scoliosis diagnosed in adolescents, and it’s much harder to treat.

During this period, the patient’s thorax and spine are still developing, but lung growth must remain the primary focus.

EOS is a condition which occurs in children before the age of 10, and it is responsible for 10% of all scoliosis cases in paediatric patients.

There are 4 types of early-onset scoliosis:

Syndromic scoliosis: It’s linked with neurofibromatosis, and defects in the vertebrae, anal atresia, cardiaological system, and renal abnormalities, limb defects, and tracheoesophageal fistula.

Neuromuscular Scoliosis: Neuromuscular disorders like muscular dystrophy or cerebral palsy contribute heavily to this condition.

Congenital Scoliosis: Caused due to a congenital disability in the segmentation and formation of vertebrae.

Structural scoliosis: Caused due to structural issues such as chest wall defects, diaphragmatic hernia, and fused ribs.

Juvenile scoliosis affects patients aged between 3-10, and infantile scoliosis affects patients younger than 3 years old. A heterogeneous spectrum of causes are responsible for EOS.

These include idiopathic scoliosis, neuromuscular scoliosis, structural scoliosis, congenital scoliosis, and syndromic scoliosis.

EOS is a combination of several disorders. At the moment of presentation, deformities and co-morbidities strongly influence the prognosis. This is attributed to the syndromic aspect of the presentation, or to the influence of the curve on thoracic function and growth.

In infants, there is significant lung development in the first 2 years of life, and their alveoli mature by the age of 8. However, in those with restricted thoracic function because of the development of scoliosis may have complications such as abnormal ventilation, decreased lung tolerance, and alveolar hypoplasia.

The prognosis of EOS is greatly influenced by the patient’s skeletal maturity and the severity of the deformity. The thoracic to sacral spine grows roughly 2 centimetres per year during the first five years, 1 centimetre each year from ages 5-10, and 1.8 centimetres every year until adulthood.

The first five years, followed by adolescence, are marked by rapid growth. Individuals aged over 40 with untreated Early-onset scoliosis have 50% higher chance of mortality. And individuals with a rib-vertebral angle over 70 degrees also have an equally higher chance of mortality.

https://www.ncbi.nlm.nih.gov/books/NBK519498/