Starship Paediatric Spine Service
Public Service Orthopaedics Paediatrics
Congenital scoliosis is defined as a lateral curvature of the spine that is the result of malformations of one or more vertebra. In the involved area of the spine there is absent or abnormal growth potential due to an area of missing bone (formation defect) or missing growth plates (segmentation defect). This disrupts the normal alignment of the spine, producing different types of deformities. The term congenital means that the condition occurs during the very early stages of pregnancy. There are many causes of congenital abnormalities. Some can be explained and others have no known causes. The process of development of a baby from a fertilised egg involves millions of complicated steps, any of which can go wrong. We do know that there was nothing that you could have done, or did not do, during pregnancy to cause or prevent this condition. The developmental defect occurred during the 4th-6th weeks of development in utero (after conception). The baby is less than an inch long during this phase of development.
One person in every 10,000 is affected and approximately 75% increase in severity and require treatment. It occurs about 60% of the time in girls, 40% in boys. Children with a congenital scoliosis are more likely to have other problems as well. The spinal column develops in utero at the same time as several other major organ systems.
Some of the problems that may be present are as follows:
Kidney or urinary tract abnormalities
Abnormalities of spinal cord development
Congenital heart defects
Talipes - club feet
Sprengel’s shoulder - shoulder deformity
Absent or fused ribs
If your doctor is concerned he may organise tests to exclude these conditions.
What is the treatment for congenital scoliosis?
Congenital scoliosis usually has serious consequences in spinal growth during childhood. The severity of the congenital deformity depends on the type of anomaly, the site at which it occurred, and how much growth the child has left.
Goals of treatment:
- To allow the child to reach the end of growth with a reasonably straight, balanced spine.
- To allow the spine to grow as much as possible.
- For younger children, allowing for the chest cavity to grow and develop and allowing the lungs to increase in size.
Observation is appropriate for small curves and balanced patterns of malformations. Some patterns of congenital scoliosis are minor enough that no treatment is needed and the long-term prognosis is good.
Surgery is often the treatment of choice because 75% of curves are progressive. Surgery is used to attempt to maintain spinal balance while preserving as much trunk height as possible during growth.