Early-onset scoliosis refers to a spinal deformity that occurs before the age of 10 years. The etiology of early-onset scoliosis will be reflected in the future: Li Ning, Department of Orthopaedics, First Affiliated Hospital of Zhengzhou University Classification of early-onset scoliosis: l Idiopathic scoliosis: there is no significant correlation between the scoliosis and the underlying etiology Idiopathic scoliosis occurs in infants and children younger than 3 years of age. l Congenital scoliosis: the vertebral dysplasia occurs in the womb Congenital scoliosis is sometimes associated with cardiac and renal developmental abnormalities. Cardiac and renal function must be evaluated. l Thoracic scoliosis: occurs in two conditions: fusion of multiple congenital ribs, resulting in congenital vertebral anomalies (which may also be referred to as congenital scoliosis), and post-thoracic surgery changes in the chest wall resulting in spinal deformities. l Neuromuscular scoliosis: occurs in children who have been born with scoliosis for more than three years. l Neuromuscular scoliosis: scoliosis originating from childhood neuromuscular disorders, including spinal muscular atrophy, cerebral palsy, and cerebral or spinal ganglion injuries l Symptomatic scoliosis: specific symptoms, such as Marfan’s syndrome, and other disorders of the junctional hoof tissue. Prognosis of early-onset scoliosis: l The diagnosis of early-onset scoliosis depends on the severity of the scoliosis, which is associated with increased problems with lung function in childhood and in adulthood. l If untreated, the increased risk of death from severe early-onset scoliosis is associated with lung function l Poor chest syndrome is commonly used to describe the potential spine- and lung-related problems of early-onset scoliosis. l Idiopathic scoliosis with a Cobb angle greater than 35° usually progresses. l Most children with a Cobb angle of less than 35° in infancy and less than 2 years of age have untreated scoliosis. l The prognosis of early-onset scoliosis depends on the combination of a number of underlying disorders. Evaluation of early-onset scoliosis: l X-ray: adequately diagnoses early-onset scoliosis. l MRI: demonstrates scoliosis with a Cobb angle greater than 20° or progression or symptomatic signs of abnormal neurologic problems in infancy. l CT: optimizes the diagnosis of scoliosis. l CT: optimizes the prognosis of scoliosis. l CT: can optimize the bony anatomy of scoliosis. Goals of treatment for early-onset scoliosis: l Minimize the patient’s spinal deformity l Maximize the patient’s lung volume and function l Minimize the patient’s spinal fusion and maximize lung and spinal motion l Minimize the patient’s complications, procedures, hospitalization costs, and family burdens l Consider the overall development of the child Treatment of early-onset scoliosis: l Observation Evaluate by regular physical examination and imaging Progression of scoliosis l Brace or cast Minimize progression of scoliosis when growth is allowed. Braces or casts are rarely useful in congenital scoliosis, but some specialists believe that bracing or casts are beneficial. l Surgery n In adherence to the principles of treatment for early-onset scoliosis, various types of surgery have been designed to allow growth of the spine and lungs under conditions that control the progression of the deformity. Surgery is usually taken after treatment with a brace or cast has failed. n In younger pediatric patients, extensive thoracic fusion is compromised with the development of lung function, and its rarely the best treatment option. l Functional exercise Functional exercise has not been shown to have an effective impact on the treatment of scoliosis.