Management options in early-onset scoliosis: A summary of current evidence

Early-onset scoliosis (EOS), defined as spinal deformity presenting before 10 years of age, is a complex condition with significant implications for thoracic growth, pulmonary development, and long-term cardiopulmonary function. Progressive deformity during early childhood can result in thoracic insufficiency syndrome and restrictive lung disease, making early recognition and appropriate intervention critical. The primary objective of EOS management is to control spinal deformity while preserving spinal and thoracic growth until skeletal maturity, thereby optimizing respiratory function and overall quality of life. This narrative review summarizes current evidence on both conservative and surgical management strategies for EOS. Non-operative measures, including serial casting and bracing, remain useful in selected cases, particularly idiopathic EOS, where they may slow curve progression or delay the need for surgery. However, their effectiveness is limited in congenital and neuromuscular scoliosis. Consequently, several growth-friendly surgical techniques have been developed to address deformity while maintaining spinal growth. These include distraction-based systems such as traditional growing rods, magnetically controlled growing rods, VEPTR, and newer self-expanding and spring-based devices; growth-guidance techniques including the Luque trolley, Shilla growth guidance system, and active apex correction; and compression-based strategies such as vertebral body stapling and vertebral body tethering. Each technique offers distinct advantages and limitations with respect to deformity correction, growth preservation, complication rates, reoperation burden, and cost. Definitive procedures such as hemivertebra excision and vertebral column resection remain important options in carefully selected cases of congenital deformity. Despite advances in surgical technology and understanding of growth modulation, no single treatment modality has proven universally superior. Management decisions should be individualized based on patient age, etiology, curve characteristics, growth potential, and risk profile. Ongoing innovation, long-term outcome data, and high-quality comparative studies are essential to refine treatment strategies and improve outcomes in children with early-onset scoliosis.