Testing and diagnosis of early-onset scoliosis

Prompt diagnosis of early-onset scoliosis is important for successful treatment of spinal curves and the best long-term results for your child. Untreated early onset scoliosis will likely have a more negative impact on your child’s overall health than the more common forms of scoliosis that occur in adolescents. A CHOP orthopedic physician will get your child’s complete medical history, perform a physical exam and look at the curvature of your child’s spine to evaluate for scoliosis.

Imaging (X-rays) will take a closer look at your child’s spine to see if there are any problems with their bones and to measure what degree of curvature is present. X-rays are the primary way we diagnose early-onset scoliosis and the exact angles of the curve. At CHOP we have multiple EOS machines that offer lower dose radiation for X-ray imaging of your child.

If the curve pattern of your child’s spine is not typical or if there is something unusual in the X-ray, your child’s physician may order one of the following tests to provide more information:

• EOS imaging, is a low-dose, 3D imaging system that scans your child standing up. An EOS scan shows us your child’s natural, weight-bearing posture and allows us to see how the joints interact with the rest of their musculoskeletal system, especially the spine, hips and legs.
• Magnetic resonance imaging (MRI) uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures inside the body. An MRI does not expose your child to radiation.
• Computed tomography (CT) scan uses a combination of X-rays and computer technology to produce cross-sectional images (“slices”) of the body. CT scans are helpful in detecting ribcage problems.

Additionally, if your child has other associated health issues, your doctor may order other exams or consult with experts from cardiology, pulmonology, nephrology or other specialties. If your child has other orthopedic concerns associated with early-onset scoliosis, our pediatric orthopedic specialists can provide expert care for these conditions as well.

How is early-onset scoliosis treated?

Here at CHOP, we practice collaborative, family-centered care. A team of expert clinicians — including leading orthopedic physicians and surgeons, nurse practitioners, physician assistants, pediatric nurses, physical and occupational therapists, and other specialists — partner with you in the care of your child.

Some children with early-onset scoliosis do not require treatment; their condition may not worsen or may correct itself as they grow. 

Other children with progressive curves may need immediate treatment to prevent chest wall deformity and allow normal lung development. We will closely monitor your child with early-onset scoliosis to determine which treatment path is best for them.

In planning your child’s individual early-onset scoliosis treatment, our team of specialists will consider the severity of the curve, where it occurs in the spine, your child’s age and stage of growth, and your child’s other health conditions.

Non-surgical scoliosis interventions

Regular monitoring for early-onset scoliosis

Some patients with early-onset scoliosis do well without surgery and may only need to be monitored regularly by a physician to ensure the curve does not worsen. Monitoring may include regular observation, X-rays and additional imaging.

Back brace for early-onset scoliosis

For some patients, the doctor may prescribe a back brace as treatment. Recent studies, including the NIH-funded BrAIST trial conducted at CHOP and other major scoliosis centers, proved that braces are very successful in halting the progression of scoliosis.

The goal of bracing is to prevent the progression of scoliosis as your child grows. The brace is designed to help correct the spine in three dimensions (3D bracing). Bracing helps guide the spine into a better position while your child is still growing and wearing the brace. It should be worn most of the time (16-20 hours a day) for best results.

Back bracing may also be recommended as treatment leading up to – or immediately after –spine surgery.

Body casting for early-onset scoliosis

Serial body casting may also be recommended. This is often chosen for children between the ages of six months and six years with X-ray measurements that suggest that their curve will worsen. Unlike a brace, the cast has the potential to straighten your child’s curve partially or completely. Other times, when correcting the curve is not possible, the cast treatment can be used to delay the need for implant surgery.

Our surgeons use the elongation-derotation-flexion technique popularized by British orthopedic surgeon Min. H. Mehta, FRCS. The treatment, also known as Mehta casting, involves placing a body cast from your child’s armpits to their lower trunk while they are under anesthesia. The process is repeated every few months as your child grows. The treatment usually lasts 1-3 years.

Surgical scoliosis interventions

Surgery is discussed for children with spinal curves greater than 50 degrees that have progressed despite nonoperative treatment.

Your child’s orthopedic surgeon will determine which surgery is right for your child depending on your child’s age, size of the curve, whether their bones (skeletal system) have reached their adult size and form (skeletal maturity) and other health considerations. Each child is evaluated individually, and treatment is suggested based on their unique long-term health needs.

Growing rods

For children who have many years of growth remaining, a growth-friendly treatment option is preferable. In growing rod surgery, the curve in your child’s back is spanned by one or two rods next to the spine. The rods are attached above and below the curve. The growing rods help guide new spinal growth and drive your child’s spine straight.

As your child grows, they will return to CHOP regularly, often every 6 to 12 months for outpatient surgery to have the growing rods expanded. This approach minimizes spinal deformity, maximizes spine growth and allows continued lung development as your child grows.

Our surgeons have pioneered the use of magnetically adjustable growing rods. These rods can be adjusted in the doctor’s office without the need for a surgery or general anesthesia. This technology has greatly reduced the number of surgeries that growing rod patients require.

Vertical expandable prosthetic titanium ribs (VEPTR)

The vertical expandable prosthetic titanium rib (VEPTR) allows continued spine growth and enhances lung (pulmonary) function. Developed by the late Robert M. Campbell Jr., MD, once one of CHOP’s leading orthopedic surgeons, the VEPTR is the most advanced treatment option for children with thoracic insufficiency syndrome (TIS), a rare condition.

Children with TIS have severe deformities of the chest, spine and ribs that prevent normal breathing and lung development.

VEPTR straightens the spine and expands the space available for your child’s lungs and other internal organs to grow. VEPTR devices can be attached to your child’s spine, rib, or pelvis, and multiple devices can be implanted depending on your child’s individual needs.

Like growing rods, VEPTR is surgically adjusted as your child ages and reaches full skeletal maturity.

Vertebral body tethering (VBT)

Our surgeons were among the first to perform vertebral tethering surgery. Learn more about this surgical treatment.

Spinal fusion

During spinal fusion surgery, the abnormal curved spinal bones are realigned and fused together. Metal implants are also inserted to correct the curve.

Spinal fusion will stop your child’s spine from growing in the area that it is fused, which is why the procedure is generally not recommended as an initial treatment for early-onset scoliosis in younger children who are still growing.

The results of spinal fusion are much more positive if the surgery is performed once your child is at or approaching skeletal maturity. For adolescents who have achieved normal lung capacity before their scoliosis curves worsened, spinal fusion can improve their quality of life and life expectancy.

Safety in spine surgery

Surgery can dramatically improve the long-term outcomes for your child with early-onset scoliosis, but it can also be a stressful experience for you and your child. At CHOP, we offer a wealth of resources that can help you and your child prepare for surgery.

Additionally, we follow many best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. Our practices have been adopted by many other children’s hospitals around the world. Some safety protocols our orthopedic surgical team uses include:

• A strict antibiotic protocol before we operate
• The use of innovative navigation and imaging equipment during surgery, like  StealthStation® and O-arm® Surgical Imaging
• Continuous monitoring of your child’s anesthesia during surgery, including specialized spinal cord monitoring
• Procedures after we operate (postoperative clinical pathways) to ensure quality standards, and rapid patient recovery

To learn more, read how we make safety in surgery a top priority.

Follow-up care for children with early-onset scoliosis

After treatment — whether surgical or nonsurgical — your CHOP orthopedic team will continue to follow up on your child’s care at our Philadelphia Campus or one of our CHOP Care Network locations.

We may use “EOS micro-dose” as part of your child’s follow-up care. CHOP was the first institution in the U.S. to introduce this imaging for use in scoliosis follow up care. Micro-dose imaging uses one-third of the standard EOS radiation dose, further reducing radiation exposure for children who may require frequent imaging.

We recognize that your child's pediatrician is an important part of the clinical team and will provide regular updates on your child’s progress. If they require continued care and monitoring, we will help transition your child's care to an adult orthopedic team.

Outlook

The outlook for patients with early-onset scoliosis has improved greatly in the past 10 years.

• Starting treatment early, especially when the spine’s curve is between 20-25 degrees, may lead to better outcomes. 
• Modern 3D braces have shown success in children with early-onset scoliosis, helping to reduce or stabilize the spine’s curve. There is no great data yet comparing a well-worn 3D thoraco-lumbo-sacral orthosis (TLSO) to a full body cast.
• Using casting to cure (<15 degrees) in early onset idiopathic scoliosis is highly effective. Casting is frequently used in other diagnoses (congenital/syndromic diagnoses) to try to cure the pathology, if possible, but if not, to delay the time to spine surgery. 
• Vertebral body tethering is a new technology that harnesses the growth remaining in a child’s spine to try to correct idiopathic scoliosis.
• Children who are treated for other disorders, in addition to a spinal deformity, may need long-term care into adulthood.

Why choose CHOP’s scoliosis experts?

CHOP is consistently ranked among the best in the nation for pediatric orthopedic care, according to U.S. News & World Report. Our Spine Program is one of the largest multidisciplinary programs in the world dedicated to the diagnosis and treatment of pediatric spine conditions. We have led the development and introduction of new treatments, from innovative bracing and exercise therapy to new surgical approaches.

We provide complete evaluation and treatment to thousands of babies, children and teens with spinal deformities and other conditions affecting the spine. Every spine condition is different, so treatment is determined on a case-by-case basis. We care for children with all types of scoliosis, from mild to the most severe.

We know it’s important to explore all non-surgical options when it comes to treatment for your child’s spinal condition. That’s why we focus on non-invasive treatment options first, whenever possible, including bracing, casting and special physical therapy programs. When surgery is necessary, we utilize cutting-edge navigation and imaging equipment in our operating rooms and follow enhanced safety protocols. And in the most severe cases, where the curvature of the spine causes breathing problems or restricts your child’s lung development, our Wyss/Campbell Center for Thoracic Insufficiency Syndrome is here to help.

Early-onset scoliosis frequently asked questions

What is considered early-onset scoliosis?

Early-onset scoliosis is when a child’s spine curves sideways before the age of 10. It can happen to babies or young kids and may get worse as they grow. Doctors watch it closely because it can affect the heart and lungs if not treated. There are different types of early-onset scoliosis, including scoliosis that is present at birth (congenital), scoliosis that has no known cause (idiopathic) and scoliosis associated with neuromuscular conditions.

How do you develop scoliosis?

Scoliosis can develop for different reasons. Some children are born with it, while others develop a spine curve as they grow. Doctors don’t always know why. It can also happen because of other health conditions that affect the muscles or spine. 

When is scoliosis diagnosed?

Scoliosis is usually diagnosed when your doctor sees that your child’s spine is curving sideways. This can happen during a regular checkup or if a parent or teacher notices symptoms like uneven shoulders or hips. It’s often found when children are between ages 10-15, but early-onset scoliosis is diagnosed before age 10.

Can scoliosis be fixed if caught early?

Scoliosis can’t be completely fixed, but it can be treated, managed or even corrected if it’s found early. Treatments like bracing or casting can stop the curve from getting worse and make any pain or discomfort better. In some cases, early treatment helps children avoid surgery.

Can you reverse early scoliosis?

If your child already has scoliosis, even if it’s severe, they may be able to improve it. It can take time, hard work and the right treatment to help straighten their spine so they can feel better.

Explore our Spine Program and the treatment we can provide for your child’s spinal condition.