Preoperative medical and surgical planning for early onset scoliosis

Study Design: A review of current medical and surgical preoperative planning knowledge and protocols for children with early-onset scoliosis (EOS; onset less than 5 years of age). Objective: To describe the preoperative planning process to undertake safe and effective treatment for the EOS patient. Summary of Background Data: Children with EOS present with a myriad of medical and orthopedic conditions associated with their specific diagnosis, and frequently require intensive preoperative evaluation and nutritional, pulmonary, and other support to prepare them for safe and effective treatment of the spinal/chest wall deformity. Such patients are among the most difficult and complex to treat effectively. Methods: A literature review of known conditions associated with EOS, and a summary of current surgical techniques to maintain deformity control while promoting spine and thoracic growth, was undertaken. Current recommendations for preoperative support and postoperative management of these complex patients are summarized, drawn from the experiences of the author and members of study groups focusing on EOS. Results: Preoperative assessment of respiratory function, potential for respiratory failure, and determination of objective criteria to indicate surgical management (deformity progression, lack of growth of spine and/or thoracic volume, lack of weight gain) are weighed against the potential for development of thoracic insufficiency syndrome. Magnetic resonance imaging evaluation for neuraxis abnormalities is considered on the basis of diagnosis. Nutritional status, osteopenia, and airway management are evaluated to minimize postoperative complications. Current general recommendations for implants and constructs for specific deformities are reviewed. CONCLUSION.: Thorough preoperative evaluation of EOS patients provides the surgeon with the knowledge to produce a sound surgical plan for this difficult and complex to treat patient population.