Early-Onset Scoliosis & Growing-Rod Surgery

Early-onset scoliosis is a sideways curvature of the spine that appears before about ten years of age. It is treated differently from scoliosis that develops in adolescence because so much growth of the spine, chest, and lungs is still to come. The central challenge is to control the curve without sacrificing that growth — and growth-friendly surgery is built around exactly that balance. This page explains the strategies used, including growing rods and the Active Apex Correction technique developed by Dr. Garg.

What it is

In early childhood the spine, the chest, and the lungs all develop together. A scoliosis that is left to progress can distort the chest and limit lung development, while fusing a young spine too early can itself restrict that growth. Growth-friendly surgery therefore aims to hold the curve in improved alignment while allowing the spine to continue lengthening, deferring any definitive fusion until the child is closer to skeletal maturity.

Who is a candidate? (Indications)

Growth-friendly surgery is considered for carefully selected young children, typically those with:

• A significant curve that is progressing despite bracing or other non-surgical measures
• A curve appearing early in childhood, with much spinal and chest growth still to come
• A deformity threatening chest and lung development or trunk balance
• An underlying syndrome or condition that makes the curve likely to worsen with growth

The child’s age, the cause and behaviour of the curve, general health, and the balance of risk and benefit all inform the decision, which is reviewed repeatedly as the child grows.

Growth-friendly strategies

Several growth-friendly strategies exist, and the right one depends on the child and the curve:

1. Traditional growing rods are anchored above and below the curve and lengthened periodically through small operations as the child grows.
2. Magnetically-controlled growing rods can be lengthened non-invasively from outside the body using a magnetic device, which can avoid many of the repeated operations associated with traditional rods.
3. Apex-directed correction focuses the corrective effort on the most curved part of the deformity.

In each case the aim is the same: to keep the curve under control while the spine continues to lengthen, protecting the developing chest and lungs.

The Active Apex Correction (APC) technique

Active Apex Correction is a technique developed by Dr. Garg specifically for early-onset scoliosis. Rather than relying only on forces applied at the ends of the construct, it directs correction at the apex — the most curved and rotated part of the deformity — with the aim of achieving and maintaining better correction through the growing years. The technique was published in the Global Spine Journal in 2024, where it received a Best Paper Award, and was further reported in NASSJ in 2025.

Benefits and risks

The benefit of growth-friendly surgery is the ability to control a progressive curve while preserving the growth of the spine, chest, and lungs, deferring definitive fusion until the child is older. Against this must be weighed the real risks of implants that remain in place over years of growth: loosening, breakage, or the need for revision surgery, infection, and the general risks of repeated anaesthesia. The strategy is chosen, and the treatment burden discussed, to keep that burden as low as possible for each child.

Alternatives

For smaller or slowly progressing curves, alternatives include observation with regular imaging, serial casting in very young children, and bracing. Where a curve is not threatening growth or balance, continued monitoring may be the most appropriate course. A specialist assessment helps determine whether surgery is genuinely necessary and, if so, which growth-friendly strategy best suits the child.

Dr. Garg’s approach & experience

Dr. Garg is Principal Director & Head, Orthopaedics & Spine at Max Hospital, Delhi, and a former Professor at AIIMS New Delhi, with more than 325 peer-reviewed publications and a long-standing interest in deformity of the growing spine. His Active Apex Correction technique for early-onset scoliosis was published in the Global Spine Journal in 2024 (Best Paper Award) and in NASSJ in 2025.

Alongside this, Dr. Garg’s research includes the development of a low-cost magnetically-controlled growth rod for early-onset scoliosis, supported by DBT and ICMR research grants, reflecting a focus on making growth-friendly treatment more widely accessible. This work sits within a broader body of deformity research that also includes robotic, navigated, and 3D-printed patient-specific approaches.

When to seek a specialist opinion

A specialist assessment is appropriate for any young child with a spinal curve, an asymmetry of the back or chest, or a curve that appears to be worsening. Early review matters in this age group because the curve, the chest, and the lungs are all still developing. Any curve associated with breathlessness, leg weakness, numbness, or changes in a child’s balance or function should be reviewed promptly.