Current Concepts in the Management of Early-onset Idiopathic Scoliosis

Ujjwal K Debnath

Disclosures

Pediatr Health. 2010;4(3):343-354. 

In This Article

Natural History

Most (92%) curvatures developing early resolve spontaneously.[10] Congenital malformations such as hiatus hernia and mental retardation are risk factors for progression.[23] The most reliable indicator of curve progression is Mehta's RVAD.[37] A RVAD of less than 20° indicates a curve that is likely to resolve in approximately 90% patients, whereas a RVAD of more than 20° is frequently associated with curves that will progress.

The primary effect of the progressive spinal deformity on the pulmonary function is mechanical.[40] The pulmonary tree is primarily affected in EOS. There is inhibition of growth of the lung and pulmonary vasculature.[41] The early age of onset directly affects the number of alveoli and development of lung.[6] There is gradual decrease in lung and chest wall compliance.[42] The vital capacity is reduced to a much greater extent in patients who develop the deformity early. The long-term clinical studies on patients with EOS by Goldberg et al. suggested that patients with resolving deformity or patients who were treated with bracing had normal or acceptable pulmonary function. On the contrary, patients who were treated surgically before 10 years of age (mean age at surgery: 4.1 years) had significant progression of deformity with deterioration of their lung function.[40] Therefore, it is important for the treating physician to gain insight into those patients who are at risk of progression. The modern instrumentation techniques may have some effect on the natural history of the disease and the final outcome (i.e., good respiratory function at skeletal maturity).

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