Early-onset Scoliosis: Current Concepts and Narrative Review

Abstract

Background: Early-onset scoliosis is a complex spinal deformity that occurs before 10 years of age and may impair spinal growth and respiratory development, requiring individualised multidisciplinary management to optimise functional and clinical outcomes. Aims: This narrative review summarises current knowledge regarding early-onset scoliosis, including its definition, aetiology, classification, clinical and radiological assessment, conservative management, surgical treatment options, complications, prognosis and future research directions. Study Design: Narrative review. Place and Duration of Study: Department of Orthopaedic and Traumatology, Faculty of Medicine, Udayana University, Bali, Indonesia. The literature included in this review was selected from studies published between 2000 and 2023. Methodology: A literature search was conducted using PubMed, Scopus and Google Scholar. The keywords used included “early-onset scoliosis”, “early-onset scoliosis management”, “early-onset scoliosis treatment”, “clinical assessment of early-onset scoliosis”, “pulmonary evaluation in early-onset scoliosis” and “surgical intervention for early-onset scoliosis”. Articles were selected if they discussed early-onset scoliosis diagnosed before 10 years of age, including diagnostic evaluation, clinical outcomes, conservative treatment, surgical management, complications and outcome assessment. Non-English articles, studies unrelated to early-onset scoliosis and studies focusing only on adolescent or adult scoliosis were excluded. Results: Early-onset scoliosis is a complex spinal deformity that may arise from idiopathic, congenital, neuromuscular or syndromic causes. Its progression can affect spinal growth, thoracic development, pulmonary function and quality of life. Appropriate assessment requires careful history-taking, physical examination, radiographic evaluation, curve flexibility assessment, pulmonary evaluation and identification of associated comorbidities. Conservative treatments such as observation, bracing and serial casting may help control curve progression and delay surgery. Surgical options include distraction-based systems, compression-based systems and guided-growth techniques. However, complications such as implant failure, infection, repeated procedures, wound problems, pulmonary limitations and unplanned revision surgery remain important concerns. Conclusion: Early-onset scoliosis requires individualised and multidisciplinary management. Treatment decisions should consider age, aetiology, curve magnitude, progression rate, pulmonary status, growth potential, comorbidities, family expectations and risk of complications. The main goals are to control spinal deformity, preserve thoracic growth, optimise pulmonary development, delay spinal fusion when possible and improve long-term functional outcomes. Further studies are needed to establish standardised assessment methods, treatment algorithms, pulmonary outcome measures, patient-reported outcome tools and long-term comparative evidence.