Current Treatment Preferences for Early Onset Scoliosis: A Survey of POSNA Members

Background: Surgical options for the management of idiopathic early onset scoliosis (EOS) have increased over the past decade, perhaps surpassing traditional nonoperative methods. We sought to assess current treatment preferences in the management of EOS among pediatric orthopaedic surgeons. We hypothesized that practitioner access to casting tables and halo traction would be significantly associated with treatment choices. Methods: A web-based survey was distributed to the members of the Pediatric Orthopaedic Society of North America. Information with regard to practice type, access to casting tables and halo traction, and management of patients with EOS was obtained. Clinical vignettes were used to assess current physician preferences in the treatment of EOS, including the use of bracing, casting, halo-gravity traction, fusionless spine techniques, definitive fusion, and chest wall devices. Results: Members of Pediatric Orthopaedic Society of North America (19.8%) completed the survey with the vast majority of respondents (93.8%) treating children with EOS. Sixty-six percent of respondents had access to a casting table and 77% reported access to halo-gravity traction. Access to casting tables and access to halo-gravity traction was associated with the use of casting and traction (P < 0.0001). Equal numbers of surgeons currently use casting (62%) and growing spine techniques (64.1%). Chest wall expansion was offered as a treatment option by 39.1% of surgeons, and 27% of surgeons reported the use of halo-gravity traction. Ninety-three percent of respondents chose nonoperative management of a 2-year-old child with a 50 (A) over cap degrees progressive scoliosis. In contrast, 63% of surgeons would offer surgery as the initial management to a 5-year-old child with a progressive 70 (A) over cap degrees idiopathic scoliosis. Conclusions: The majority of respondents had access to halo traction and casting tables at their hospitals. There was a statistically significant association between access to equipment and use of casting and halo traction. Nonoperative management was the preferred treatment option in the very young (2 year-old). Two-thirds of surgeons report initial surgical management of the 5-year-old child with a large idiopathic curve.