Table 2, continued
Age group	Guidelines		Evidence
6–12 years11 months	7.	It is recommended that surgical treatment of scoliosis be reserved for a progressive deformity that is unresponsive to non-operative management. An example is when the scoliosis has progressed in spite of bracing and after a neurosurgical cause, such as a tethered cord, has been ruled out. It is also recommended that management with growing rod surgery and fusionless technique should include spinal cord monitoring in children with distal neurologic function. Growing rod surgery with sacral-pelvic fixation is effective in correcting deformity and achieving growth.	[26, 29]
	8.	Consider surgical treatment of gibbus deformity for intractable skin breakdown or to free up the upper limbs for independent sitting. The current literature describes multiple techniques.	[8, 9, 27, 30–33]
	9.	Teach children and families about fractures and related precautions.	Clinical consensus
13–17 years 11 months	1.	Monitor for the development or progression of scoliosis clinically, with radiographs as necessary, if indicated by physical exam. Perform radiographs in a sitting position in those who can sit but not stand and in a standing position in those who can stand. If the curve has progressed to an operative magnitude (50 degrees), discuss the risks and benefits of surgical treatment with the family.	Clinical consensus
	2.	Monitor for the deterioration of gait and consider treatment of orthopedic deformities leading to deterioration such as hip and knee contracture or rotational deformities. Computerized gait analysis may be useful for decision-making in the case of children with low lumbar and sacral level lesions.	[14, 28]
	3.	Conduct a history and physical exam (with radiographs, if indicated) on an annual basis unless greater frequency is indicated.	Clinical consensus
18$+$ years	1.	Develop an orthopedic transition plan.	Clinical consensus
	2.	Counsel the patient about potential orthopedic degenerative problems. Consider bracing across the knee such as the use of a KAFO, for patients with coronal plane valgus knee stress, or adding forearm crutches to decrease coronal and transverse plane trunk motion.	Clinical consensus Mobility guidelines
	3.	Counsel the patient about fractures and related precautions.	Clinical consensus