Early Onset Scoliosis (Ages 0-10 years)

What are the signs and symptoms of early onset scoliosis?

Many children with early onset scoliosis look and function normally, especially if the curve in the spine is mild. The key to checking for a curve or curve progression is to pay close attention to body symmetry (similarity on both sides):

• Shoulders should be level.
• Shoulder blades should be the same height and shape.
• Spine should run down the center of the back.
• Head should be centered over the pelvis.
• Hips should appear level.
• Child should not lean to one side.
• Any creases in the skin on the back should be symmetric.

Early onset scoliosis usually doesn’t cause back pain. Children with early onset scoliosis also don’t typically have neurologic symptoms such as numbness, weakness or loss of bowel or bladder control. If these symptoms do appear, contact your doctor immediately.

What tests are used to diagnose early onset scoliosis?

Your provider will perform X-rays of the spine to diagnose early onset scoliosis. These can often be low-dose radiation images using the EOS system. They may also order an MRI to confirm there are no underlying problems with the spinal cord.

Providers often recommend ultrasounds of the heart and kidneys for children with congenital scoliosis. Congenital spine conditions can be associated with problems in these organs as well.

How is early onset scoliosis treated?

Your child’s provider may recommend a variety of treatment options based on your child's condition, including:

• Casting and bracing
• Halo gravity traction
• Short spinal fusion
• Magnetic rod treatment

Casting and bracing

Providers are increasing their use of noninvasive casting to treat early onset scoliosis. Casting guides the spine as it grows to straighten it over time. For some children, casting can prevent or delay progression of scoliosis.

A pediatric spine specialist applies your child's cast in a procedure center or operating room. Our pediatric specialists place your child under anesthesia but don’t make an incision during the application.

The cast typically needs to be changed every 2 to 4 months. The procedure is not painful, and no pain medicine is needed after applying the cast. Children can be active and play normally while wearing spine casts.

Bracing is also used for management of early-onset scoliosis. Providers often use bracing after your child's spine has been straightened with casting. Braces can also be an alternative for kids who are too old for casting or families who don’t want their child in a cast.

Halo gravity traction

Your child's doctor may recommend halo gravity traction for severe cases of early onset or adolescent scoliosis. We attach a horseshoe-shaped ring to your child’s skull and gently pull their head and spine upward to straighten their spine.

Most children respond very well to halo gravity traction. Kids may have some discomfort for 1 to 2 days after the halo is applied, and pain relief medication can help.

After the first couple of days, children generally have no pain with halo gravity traction. Many feel better with their spine stretched out than they did before traction was applied.

What to expect from procedure for applying halo gravity traction

• One of our orthopedic spine surgeons applies the halo in an operating room. After 1 to 2 days, we add weight using a novel spring-based system unique to Children's Colorado Spine Program.
• Children are encouraged to use a walker and a wheelchair to remain mobile while in traction (wearing the halo). Typically, we add weight in increments of 2 to 3 pounds until about half the child's body weight is achieved. In many cases, children can go home once they have reached their goal traction weight.
• The amount of time your child will be in traction depends on how they respond to treatment. Some children move from traction to casting, spinal fusion or magnetic controlled growing rod treatment.

Short spinal fusion

Doctors may recommend a short spinal fusion for certain cases of congenital scoliosis. We typically recommend this surgery for patients with a central area of the spine that was not formed properly, such as a single hemivertebra (malformation in the spine).

A short spinal fusion can control the spinal deformity, while allowing the rest of the spine to grow normally. This surgery is like the surgery used for adolescent idiopathic scoliosis. However, it is performed over a smaller segment of the spine and uses smaller spinal screws and rods.

Magnetic controlled growing rod treatment

Magnetic controlled growth rod (MCGR, MAGEC) treatment is an advanced approach for treating kids with early onset scoliosis. This newer technology uses a rod to lengthen your child's spine as they grow.

After the initial surgery to implant the rods, we expand the rods during office visits without the discomfort of surgery. This means your child needs fewer surgeries and less pain medication, and they miss fewer school days.

What to expect from placement of the magnetic controlled growing rod

Before surgery, you meet your child's surgeon and one of our spine nurses. We explain more about your stay at Children's Colorado, lead you on a tour and share information about the recovery and discharge process.

Surgeons place the magnetic rods during an inpatient surgery. A pediatric anesthesiologist helps your child fall and stay asleep during the surgery. Your child stays in the hospital for 2 to 3 days after the surgery before going home.

What to expect at your first rod expansion visit

• After the initial surgery when rods are inserted, your child returns to our outpatient clinic every 2 to 4 months for rod expansions.
• At the rod expansion visit, your child gets into a comfortable position on their stomach or side. A pediatric spine specialist uses an external remote control to lengthen the rods from the outside of the skin.
• The external remote control causes the magnets in the rods to make the rods longer. Your doctor decides how much to expand the rods on an individual basis.
• Rod expansion takes only a few minutes. Your child can watch TV or use a tablet during the procedure. They may feel a tingling or odd feeling in their back, but most don’t feel pain.
• After we expand the rods, your child’s doctor uses ultrasound imaging to check the length of the rod expansion. Then, you and your child can head home and return to normal life.

Learn about 10-year-old Ryan Viano, our first patient to benefit from these new magnetically controlled rods.

Benefits of the magnetic controlled growth rod

• The rod expansion is done at an outpatient visit.
• The expansion only takes a few minutes.
• There is no recovery or need to miss school or work after expansions.
• No pain medication is needed.
• Fewer X-rays are needed.

Why choose us for treatment of your child's early onset scoliosis?

At Children's Colorado, we have one of the largest early onset scoliosis programs in the country. Our pediatric specialists are core members of the Pediatric Spine Study Group and Scoliosis Research Society. We're also actively involved in cutting-edge spine research and have numerous scientific publications on scoliosis.

• The Pediatric Spine Foundation is a community dedicated to improving care quality and outcomes for patients and families dealing with chest wall and spine deformities.
• The Growing Spine Foundation is a nonprofit organization that supports medical education and scientific research to optimize the quality of life of children with early onset scoliosis.