EOS (Idiopathic) 

Background 

• Infantile <4 
• Juvenile 4-10 
• Natural history: 
  • Infantile spontaneous resolution in many (esepcially infantile) 
  • Juvenile high requirement of surgery 
• M>F 
• Left thoracic 

Risk of Progression 

• Radiographic 
  • Rib – Vert overlap at apical – high risk 
  • RVAD – rib – vert angle difference – >20 high risk 

Investigation 

• Higher incidence of neural axis anomaly 
  • Syringomyelia (cyst in cord) 
  • Chiai (cerebella tonsil protrude through bases of skull opening – CSF outflow blocked) 
  • Tethered cord 
  • Dysraphism 
• MRI in children <10 with curve >20 

Risk of neural axis abnormality in Juvenile idiopathic scoliosis? 

less than 10% 

15% to 30% 

45% to 60% 

greater than 60% 

Management 

• Observation 
  • Most resolve spontaneously 
• RVAD >20 or Rib Vert overlap -> Serial Mehta casting 
  • Milwaukee brace after to maintain 
• Operative 
  • Indications: 
    • Cobb >50 
    • Failed Mehta 
  • Timing: 
    • Before age 8 to maximize FVC 
    • Fusion close to skeletal maturity 

Operative Options 

• Growing Rod 
  • Growing Rods 
  • Lengthen q 6 months 
• VEPTR – for TIS 
  • Rib to rib 
  • Rib to pelvis 
• Eventual definitive fusion at skeletal maturity  

Pulmonary Function 

• Alveolar multiplication happen up to age 8 
• 18cm minimum thoracic height, 22 is goal 
• FVC correlated to % of spine fused 
• PFT <45% inc mortality 
• RF worse FVC 
  • Fusion to T1-2 
  • PT kyphosis >4 segments 
  • Rib deformity 
  • Extent of fusion