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Surgical treatment of early-onset scoliosis (EOS) presents unique challenges because of the long period of treatment and multiple surgical interventions. Current surgical techniques are successful in terms of deformity correction, but by looking at a wider perspective, one can see that there is much more to EOS than the radiographic deformity.
Growth-friendly treatment with growing rods have the potential to allow sufficient pulmonary development to prevent cardiopulmonary disease. Recent evidence suggests that improvements in pulmonary functions are somehow lower than expected, and repetitive procedures can result in a stiff thoracic cage.
Surgical stress is well-known to affect the psychosocial status of a child, and EOS treatment with repetitive surgeries can be overwhelming. Recent studies show significant deteriorations in the child and parents’ psychosocial status not only during the treatment period but even after the surgical treatment is over.
Metal ion release is another important issue to consider. Serum levels, especially for titanium, may remain elevated longer than expected. Radiation exposure of patients with EOS is also higher than the general population, and even with the new imaging techniques reducing ionizing radiation exposure, there could still be long-term effects that are yet unclear.
The summary of literature we provided in this comprehensive review aims to emphasize that EOS is not solely a musculoskeletal disorder, but more of a systemic one. Surgical treatment may bring lifelong impacts on the patient’s health, some being iatrogenic and others more of a disease-related nature. The non-spine outcomes of EOS treatment should not be overlooked.