title: Early onset scoliosis:  modern treatment and results.
abstract: BACKGROUND
  Early onset scoliosis (EOS) is a potentially fatal, challenging group of diseases the management of which has markedly changed in the last decade. The purpose of this review is to provide the reader with a brief description of each of these new therapeutic modalities, their indications for use, and early clinical results.
  
  
  METHODS
  A systematic review of peer-reviewed publications and abstracts related to the treatment of EOS in the last decade was carried out and synthesized into a review of modern treatment methods.
  
  
  RESULTS
  Recent advances in techniques and understanding of preserving the thoracic space have improved the morbidity and mortality of children with progressive EOS. Derotational casting may be used in younger patients with curves between 25 and 60 degrees. The vertical expandable prosthetic titanium rib is best suited for patients with thoracic insufficiency syndrome. Single or dual growing rods may be used alone or in combination with vertical expandable prosthetic titanium rib to treat patients with progressive EOS who are not candidates for casting. Shilla technique is an alternative to growing rods that avoids the morbidity of repeated lengthenings but is not as well proven as the techniques described above. Other methods such as automatic growing rods and growth modulation techniques are still investigational, and their role needs to be defined after further study.
  
  
  CONCLUSIONS
  Recent advances have improved the treatment of children with EOS. Treatment continues to be challenging with complication rates higher than treatment of idiopathic scoliosis.
  
  
  METHODS
  Level V.
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Bloomberg Children's Center, Baltimore, MD, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Tis
authors.forename: Lawrence I
authors.initials: LI
authors.lastname: Karlin
authors.forename: Behrooz A
authors.initials: BA
authors.lastname: Akbarnia
authors.forename: Laurel C
authors.initials: LC
authors.lastname: Blakemore
authors.forename: George H
authors.initials: GH
authors.lastname: Thompson
authors.forename: Richard E
authors.initials: RE
authors.lastname: McCarthy
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Tello
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mendelow
authors.forename: Edward P
authors.initials: EP
authors.lastname: Southern
mesh_terms: D017668:Age of Onset; D000818:Animals; D002370:Casts, Surgical; D002648:Child; D018450:Disease Progression; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D019736:Prostheses and Implants; D012272:Ribs / Q000601:surgery; D012600:Scoliosis / Q000503:physiopathology / Q000601:surgery*; D013577:Syndrome; D013896:Thoracic Diseases / Q000503:physiopathology / Q000601:surgery*; D013904:Thoracic Vertebrae; D014025:Titanium
chemical_list: D014025:Titanium