The treatments for early-onset scoliosis (EOS) remain great challenges for spine surgeons. This study aimed to comprehensively review the treatments for EOS, especially the advancements made in the last decade. Current studies on EOS were retrieved through a search on PubMed, UpToDate, the Web of Science Core Collection and Scopus were reviewed. The most pertinent information related to the current treatments for EOS was collected. The foci of treatments for EOS have included creating a well-developed thoracic cavity, improving lung volume, and improving pulmonary function. Conservative treatments include bracing, casting, halo-gravity traction, and physiotherapy. Serial casting is the most effective conservative treatment for EOS. Surgical treatments mainly include growth-friendly techniques, which are generally classified into three types according to the amount of correction force applied: distraction-based, compression-based, and growth-guided. The distraction-based systems include traditional or conventional growing rods, magnetically controlled growing rods, and vertical expandable prosthesis titanium ribs. The compression-based systems include vertebral body stapling and tethering. The growth-guided systems include the Shilla system and modern Luque trolley. In addition, some newer techniques have emerged in recent years, such as posterior dynamic deformity correction (ApiFix). For EOS patients presenting with sharp deformities in a long, congenital spinal deformity, a hybrid technique, one-stage posterior osteotomy with short segmental fusion and dual growing rods, may be a good choice. Hemivertebra resection is the gold standard for congenital scoliosis caused by single hemivertebra. Although the patient's growth potential is preserved in growth-friendly surgeries, a high complication rate should be expected, as well as a prolonged treatment duration and additional costs. Knowledge about EOS and its treatment options is rapidly expanding. Conservative treatments have specific limitations. For curves requiring a surgical intervention, surgical techniques may vary depending on the patients’ characteristics, the surgeon's experience, and the actual state of the country.

Background Early-onset scoliosis (EOS), defined by an onset age of scoliosis less than 10 years, conveys significant health risk to affected children. Identification of the molecular aetiology underlying patients with EOS could provide valuable information for both clinical management and prenatal screening. Methods In this study, we consecutively recruited a cohort of 447 Chinese patients with operative EOS. We performed exome sequencing (ES) screening on these individuals and their available family members (totaling 670 subjects). Another cohort of 13 patients with idiopathic early-onset scoliosis (IEOS) from the USA who underwent ES was also recruited. Results After ES data processing and variant interpretation, we detected molecular diagnostic variants in 92 out of 447 (20.6%) Chinese patients with EOS, including 8 patients with molecular confirmation of their clinical diagnosis and 84 patients with molecular diagnoses of previously unrecognised diseases underlying scoliosis. One out of 13 patients with IEOS from the US cohort was molecularly diagnosed. The age at presentation, the number of organ systems involved and the Cobb angle were the three top features predictive of a molecular diagnosis. Conclusion ES enabled the molecular diagnosis/classification of patients with EOS. Specific clinical features/feature pairs are able to indicate the likelihood of gaining a molecular diagnosis through ES.

Study Design. Retrospective study. Objective. To evaluate clinical outcomes of dual growing rod (GR) technique in treating children with congenital scoliosis (CS). Summary of Background Data. Published reports on the dual GR technique results of early-onset scoliosis demonstrate it to be safe and effective. However, the use of GR in congenital spinal deformities is controversial, and there have been no reports on the results and complications of dual GR technique for CS with large series of patients. Methods. During 2004 to 2009, a total of 30 patients with CS underwent dual GR procedures. Of the 159 total procedures conducted within the treatment period, 125 were lengthenings with an average of 4.2 lengthenings per patient. Five patients with severe rigid deformity or kyphosis had an osteotomy at apex vertebra with short segmental fusion. The analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographical evaluation was conducted. Results. The mean scoliosis improved from 72.3° to 34.9° after initial surgery and was 35.2° at the last follow-up or after final fusion. T1–S1 length increased from 25.42 to 29.03 cm after initial surgery and to 33.32 cm at last follow-up or after final fusion with an average T1–S1 length increase of 1.49 cm per year. The space available for lung ratio in patients with thoracic curves improved from 0.84 to 0.96 at the latest follow-up. Three patients reached final fusion. Complications occurred in 7 of the 30 patients, and they had a total of 13 complications. Conclusion. The dual GR technique is safe and effective in the treatment of selected cases of long, complex CS. It maintains correction achieved at initial surgery while allowing spinal growth to continue. And it has an acceptable rate of complications. The osteotomy at the apex vertebra with short segmental fusion of the severe rigid scoliosis or the patients with kyphosis could help to improve the correction and decrease the implant failures, with little influence on the length of the spine.