Evaluation and Treatment of Early-Onset Scoliosis

Update on the Diagnosis and Management of Early-onset Scoliosis

PURPOSE OF REVIEW

In this article, we review the most recent advancements in the approaches to EOS diagnosis and assessment, surgical indications and options, and basic science innovation in the space of early-onset scoliosis research.

RECENT FINDINGS

Early-onset scoliosis (EOS) covers a diverse, heterogeneous range of spinal and chest wall deformities that affect children under 10 years old. Recent efforts have sought to examine the validity and reliability of a recently developed classification system to better standardize the presentation of EOS. There has also been focused attention on developing safer, informative, and readily available imaging and clinical assessment tools, from reduced micro-dose radiographs, quantitative dynamic MRIs, and pulmonary function tests. Basic science innovation in EOS has centered on developing large animal models capable of replicating scoliotic deformity to better evaluate corrective technologies. And given the increased variety in approaches to managing EOS in recent years, there exist few clear guidelines around surgical indications across EOS etiologies. Despite this, over the past two decades, there has been a considerable shift in the spinal implant landscape toward growth-friendly instrumentation, particularly the utilization of MCGR implants. With the advent of new biological and basic science treatments and therapies extending survivorship for disease etiologies associated with EOS, the treatment for EOS has steadily evolved in recent years. With this has come a rising volume and variation in management options for EOS, as well as the need for multidisciplinary and creative approaches to treating patients with these complex and heterogeneous disorders.

Weight gain and gastrostomy tube safety during serial body casting for early onset scoliosis

PURPOSE

Serial casting has been shown to improve curve deformity for patients with early-onset scoliosis (EOS). However, despite prior literature demonstrating the importance of weight and nutrition in EOS patients, there is limited information regarding complications and weight gain ability for children undergoing serial casting. Additionally, parents of patients undergoing serial casting often have concerns regarding weight gain and patient comfort, which tend to be amplified in patients with gastrostomy tubes (g-tubes). We aim to understand changes in weight, g-tube complications, and cast-related complications in patients being treated with serial casting.

METHODS

A single center retrospective review of all EOS patients less than 6 years old treated with serial casting was performed. Patient weight out of cast throughout their treatment was converted to a percentile based on CDC growth charts. Patients with documented calls regarding cast concerns, complications requiring cast removal, or g-tube procedures were recorded.

RESULTS

A total of 32 patients treated with serial casting were included with four having g tubes. Overall, the average weight percentile increased from pre-casting to post-casting (27-38%, p < 0.001) with 21 patients showing an increase. Of the 22 patients with a starting weight below the 25th percentile, 14 (64%) demonstrated an increase. Patients with g tubes increased an average of 4.2 kg during casting compared to 3.0 kg in patients without g tubes (p = 0.588). 18 parents registered a cast concern during the treatment and 5 patients required at least one early cast removal. No difference in cast concerns (p = 0.597) or cast removals (p = 0.488) was observed when comparing patients with g tubes to those without. There were no instances of g-tube dysfunction during casting.

CONCLUSION

While the average weight percentile for patients initiating serial casting is below average, the majority increased their weight percentile during treatment. Patients with and patients without g tubes were able to maintain or gain weight during casting treatment. While it was common for parents to contact providers with cast concerns, patients with g tubes did not appear to have a greater risk of cast or g tube-related complications.

LEVEL OF EVIDENCE

Level IV.

Scoliosis incidence and treatment methods

Scoliosis is defined as a three-dimensional deformity of the spine that is of particular interest to the lateral curvature of the spine. Various types of treatment approaches have been recommended for patients with scoliosis. The aim of this study was to provide an up-to-date review of scoliosis, focusing on issues such as its incidence and treatment methods. The ISI-Thomson Web Of Science International Virtual Library was accessed for this review. The search criteria selected were 'title', 'abstract' and 'keywords'. In the ISI Thomson Web of Science virtual library platforms, the keywords in the articles search were "scoliosis incidence" and "scoliosis treatment". Over the years, different therapeutic strategies have been addressed for patients with scoliosis, they differ depending on the type of scoliosis, the patient's age and the available therapeutic means. Keywords: Scoliosis, Incidence, Physical Treatment;

Developments, Focuses, and Trends in Early-Onset Scoliosis From 2005 to 2020: A Systematic Bibliometric Analysis

OBJECTIVE

Although several studies have been reported on early-onset scoliosis (EOS), a bibliometric analysis is still lacking. A systematic bibliometric analysis will enable researchers to understand the scope of the research topics, identify research focuses and key literature, and predict future research directions.

METHODS

Literature data were retrieved from the Web of Science Core Collection database. The Web of Science Results Analysis and Citation Report were used to analyze the reported studies in different views. CiteSpace and VOSviewer were used for further analysis, including a cooperation network analysis of the authors, institutions, countries and/or regions, discipline and journal analysis, reference co-citation analysis, and keyword co-occurrence analysis.

RESULTS

The final analysis included 674 relevant studies reported from 2005 to 2020. During the study period, the field of EOS has expanded rapidly. Multiple cooperation was found among the authors, institutions, and countries and/or regions, with some making great contributions. The results of the reference co-citation analysis showed that the studies had several main focuses, including the growing rod (GR), magnetically controlled GR, an EOS 24-item questionnaire, and a growth evaluation.

CONCLUSIONS

From 2005 to 2020, surgical treatment has remained the focus of research in the EOS field. The magnetically controlled GR is the latest research focus, which might become more comprehensive in the future. The Gr has remained the most popular topic, and potential new surgical techniques might require improvement to become the favored techniques. In addition, assessing the health-related quality of life and growth parameters of patients with EOS have become a popular topic.