Congenital Scoliosis

Congenital scoliosis is the lateral curvature of the spine that happens in children whose vertebrae do not form normally while they develop in the womb. This abnormality begins in the fetus at four to six weeks of gestation. It is present at birth and may be associated with other health problems such as kidney or bladder diseases.

How we identify congenital scoliosis

This condition is usually noticed because of a slight back abnormality. Other physical signs include:

  • Uneven shoulders
  • Uneven waistline
  • One hip higher than the other
  • Overall appearance of leaning to one side

Diagnosis

Congenital scoliosis is usually detected when the child is born. A pediatrician often notices a slight back abnormality. Common diagnostic testing can confirm the condition.

  • An X-ray shows the abnormal vertebra.
  • An MRI scan checks for spinal cord abnormalities.
  • A CT scan shows a detailed image of the spine.
  • An ultrasound scan can detect any problem that has affected your child’s kidneys.
  • Your child is observed every four to six months.

If your child has small curves and balanced patterns of malformation, then the impact may be minor and your child may not need treatment. Your child’s doctor will check these changes using X-rays, which are taken during a time of rapid growth.

Possible causes

Some of the common abnormalities that happen during fetal development include:

  • Incomplete formation of vertebrae: One part of the vertebra is not completely formed, which results in hemivertebrae. Hemivertebrae creates a sharp angle in the spine, which causes the spine to curve as the child grows.
  • Failure of separation of vertebrae: As a fetus develops, at first its spine forms as a single tissue. Later it divides into segments that become the vertebrae. If the separation does not take place, it results in partial fusion of two or more vertebrae, which is called an “unsegmented bar.” This unsegmented bar prevents the spine from growing straight and results in a spinal curve.
  • Combination of bars and hemivertebrae: An unsegmented bar on one side of the spine, and a hemivertebra on the other, lead to more curvature of the spine.
  • Compensatory curves: This is when a child’s spine creates other curves in the opposite direction, above or below the affected area, as a way to make up for the scoliosis curve. The vertebrae appear normal in shape.

Treatment 

Some of the treatments include:

  • Braces or casts: Sometimes braces or casts can control the curves that are near the abnormality of the vertebra. This may keep them from getting worse.

  • Spinal fusion surgery: In a spinal fusion, we remove the abnormal vertebra and replace it with bone grafts.

  • Hemivertebra removal: In this procedure, the hemivertebrae or abnormally shaped vertebrae are removed. Then, the vertebrae above and below the hemivertebrae are fused together with the help of metal screws. This procedure helps straighten the spine and allows the closest portion of the spine to grow normally. After the surgery, your child will wear a cast or splint to prevent movement and bring about fusion of the vertebra.

  • Reconstructive osteotomy and instrumentation: This procedure is done if your child’s spine deformity causes breathing problems; causes pain and risks damaging the spinal cord; or impairs the torso shape. In such cases, osteotomy is done to remove part of the vertebral column. Then, internal fixators, such as metal rods, hooks, screws, and wires, will be used to restore the spine’s balance. 

  • Physical therapy: Your doctor will advise physical therapy after the surgery to help your child’s spine grow normally. Physiotherapists will first evaluate your child’s posture, muscle strength and flexibility. Then, they will design exercises to help control pain and improve your child’s disability.