Congenital Scoliosis
Congenital scoliosis is a sideways curve of the spine caused by a vertebral defect present at birth.
It normally occurs in 1 out of 10,000 newborns and is much less common than other forms of scoliosis. Children with congenital scoliosis can sometimes have other health issues, or the abnormality can go unnoticed until adolescence.
Types of Congenital Scoliosis
Incomplete Formation of Vertebrae
During fetal development, the spine and vertebral column develops first as a single column of tissue and later becomes segmented to form the bony vertebrae. Sometimes a vertebra will not completely form, becoming what is known as a hemivertebrae. This vertebra will cause a sharp angle in the spine and a curvature that can worsen as a child grows. The abnormality can occur at 1 vertebra in the spine or many vertebrae.
Failure of Separation of Vertebrae
If during this time of vertebral development, the tissue does not fully separate, it may result in a partial fusion (bars) between vertebrates. As a result, as the child grows, the connection will prevent the spine from growing evenly and properly, resulting in a curve. Both failures of separation and incomplete formation can occur together.
Symptoms
Congenital scoliosis is usually not painful and is normally detected during routine exams when a child reaches adolescence. Physical signs include:
Child leans to 1 side
Ribs are more prominent on 1 side
Tilted, uneven shoulder
Uneven hip
Weakness, numbness or loss of coordination, if spinal cord is affected by curve
If your child has symptoms of congenital scoliosis, your doctor will recommend other tests to check for abnormalities, including:
X-rays: By looking at X-rays of your child’s back from behind and the side, a doctor can determine how severe the curve is and if there is an abnormal vertebra.
CT scans: Provide doctor detailed images of your child’s spine showing the size, location and shape of any abnormalities.
Magnetic resonance imaging (MRI): Provides images of the soft tissues within the body. This test will be done at least once to check for abnormalities that cannot be seen on X-ray.
Non-surgical Treatments
Observation
When a child grows, the curve can get worse, making the deformity more noticeable. Therefore, children with a small curve are monitored to make sure the curve does not progress. A doctor will schedule appointments every 6–12 months to monitor the curve.
Bracing /Casting
Bracing and casting are rarely used. When they are used, they help control the part of the spine that does not have vertebral defects.
Surgical Treatments
Spinal Fusion
The abnormal segments of the spine are fused together to create 1 continuous solid bone. The growth of the spine is stopped, and it prevents the curve from progressing and getting worse.
Hemivertebrae Removal
The abnormal vertebrae are removed, partially correcting the curve. Metal implants are placed to help stabilize the surrounding segments as they fuse together.
Growing Rods
For young children with significant curves, rods are attached to the spine and/or ribs to control the curve and to allow the spine to continue to grow. The rods are lengthened every 6–8 months until the child is fully grown, at which time a spinal fusion is performed.