Congenital Scoliosis

Congenital scoliosis is the lateral curvature of spine that occurs in children whose vertebrae are abnormally formed during their development in the womb. This abnormality develops in the fetus at 4 to 6 weeks of gestation. It is present at birth and may be associated with other health problems such as kidney or bladder diseases.

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

• Incomplete formation of vertebrae - One part of the vertebra is incompletely formed resulting in hemivertebrae. Hemivertebrae creates sharp angle in the spine which causes the spine to curve as the child grows.
• Failure of separation of vertebrae - During development, initially the spine forms as a single tissue which later divides into segments that develop into the vertebrae. If the separation does not take place it results in partial fusion of two or more vertebrae. This unsegmented bar prevents the spine from growing straight resulting in a spinal curve.
• Combination of Bars and Hemivertebrae - Unsegmented bar on one side of the spine and hemivertebra on the other result in increased curvature of the spine.
• Compensatory curves - During this condition your child's spine will create other curves in opposite direction above or below the affected area so as to make up for the scoliosis curve. The vertebrae appear normal in shape.

Congenital scoliosis is usually detected at the time of birth, during examination by your pediatrician because of a slight back abnormality. Other physical signs such as uneven shoulders and waistline, one hip higher than the other, overall appearance of leaning to one side may be seen.

Congenital scoliosis can be detected by some of the diagnostic tests. The common tests include X-ray, to disclose the abnormal vertebra; MRI scan to check for the abnormalities of spinal cord; CT scan to show a detailed image of the spine; and an ultrasound scan to detect any problem that has affected your child's kidneys.

The treatment modalities include non-surgical and surgical methods. Non-surgical treatment consists of observation of the child at 4 to 6 months intervals. If the child has small curves and balanced patterns of malformation, then they can be minor and requires no treatment. Your doctor will observe these changes by X-rays which are taken during the period of rapid growth. Braces or casts are used to control the compensatory curves that are adjacent to the congenital abnormality of vertebra to prevent them from worsening.

Surgical options include:

• Spinal fusion - It involves removal of the abnormal vertebra and replacement of vertebrae with bone grafts. Two or more vertebrae are fused together with the help of bone grafts and internal fixators such as metal rods, wires, hooks, or screws to form one single bone. These internal fixators help to stabilize the fusion and partially help to straighten the spine. After the surgery, your child should wear cast or splint to help in healing process.
• Hemivertebra removal - In this procedure, the hemivertebrae or abnormally shaped vertebrae are removed and the vertebrae present above and below the hemivertebrae are fused together with the help of metal screws. This procedure helps to straighten the spine and allows the adjacent portion of the spine to grow normally. After the surgery, your child should wear a cast or splint to prevent mobilization and bring about fusion of vertebra.
• Growth rod insertion - Spinal fusion surgery will not be effective in growing child and may cause impairment of the chest and growth of the lungs. Therefore, before going for surgery your doctor will advise insertion of growth rods. One or two rods will be attached to the spine above and below the curve allowing the spine to grow while correcting the curvature. These rods will be kept in place until the child is completely grown after which spinal fusion surgery will be performed.
• Reconstructive osteotomy and instrumentation - This procedure is done if your child's spine deformity causes breathing problems, pain and risk to the spinal cord, or impairment of the torso shape. In such cases osteotomy is done to remove part of the vertebral column and then followed by insertion of internal fixators such as metal rods, hooks, screws, and wires to restore the balance of the spine.
• 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 and will design exercises that help to control pain and improve your child's disability.