What is congenital scoliosis?
Congenital scoliosis is a lateral curvature of the spine due to abnormal development of the spine during the embryonic period and abnormalities in the adjacent supporting tissues. The cause of congenital scoliosis is unclear, but it is currently thought to be due to abnormal embryonic development, and genetic factors may have little influence.
Can congenital scoliosis be combined with other deformities?
Congenital scoliosis is associated with many other anomalies, the most frequent of which are genitourinary anomalies, such as single kidney, double ureter, crossed kidney ectopic, and urinary tract obstruction. In addition, there are often many other anomalies, such as congenital heart disease, high scapular deformity, short neck deformity, total or hemi-sacral hypoplasia, and atresia of the anus. There are also many patients with combined spinal cord anomalies, of which longitudinal spina bifida, spinal cord embolism syndrome is the most common. Therefore, patients with congenital scoliosis should be examined thoroughly to make a correct diagnosis.
How does congenital scoliosis develop?
This deformity develops at birth, and thus patients develop the deformity earlier than in idiopathic scoliosis. Early onset makes it rare for patients with congenital scoliosis to receive the best early treatment. Because the formed curvature tends to progress and the patient still has a long growth span, it tends to produce more severe deformities. Congenital scoliosis is usually more rigid and difficult to correct.
How does congenital scoliosis progress?
The most important thing to determine in congenital scoliosis is the progression of the scoliosis, but sometimes the decision is difficult to make at the initial consultation. For example, in some patients with mixed deformities, progression is less likely because of the presence of multiple deformities at the same time, including hemivertebrae, bony bridges, and different parts of the deformity may cancel each other out and bring the spine into balance. In this way, close follow-up is required to make a timely and correct assessment of the potential for progression of the deformity.
Congenital scoliosis types and progression
The prognosis of the types of deformities in congenital scoliosis, in descending order of severity, is: unilateral malsegmentation combined with convex hemivertebrae, unilateral malsegmentation, ipsilateral double hemivertebrae, free hemivertebrae, fused hemivertebrae and blocked vertebrae. The prognosis by segment involved in scoliosis, in order from poor to good, is.
Thoracic segment, lumbosacral segment, cervicothoracic segment, thoracolumbar segment and lumbar segment.
Is non-surgical treatment appropriate for congenital scoliosis?
The most important principle in the treatment of congenital scoliosis is the prevention and control of the progression of the deformity. Non-operative treatment includes follow-up and bracing and is mainly indicated for types with an uncertain natural history and prognosis; however, bracing is not as effective as for idiopathic scoliosis. However, bracing is not as effective as for idiopathic scoliosis, and is contraindicated for faster progression, poor prognosis and concomitant kyphosis.
Can congenital scoliosis be treated non-surgically?
There is urgency in the treatment of congenital scoliosis, and if progression is detected, even relatively small changes in curvature mean that surgery is required. This is the most conservative approach, as having surgery early usually allows the patient to avoid having to undergo larger surgeries later. It is not uncommon for children between the ages of one and one and a half years to undergo surgical procedures that are relatively minor in nature. Non-surgical treatment requires observation every 4 to 6 months, and if progression is noted, surgery is indicated. Back bracing is only used in a small number of patients where compensatory curvature occurring close to the congenital anomaly can be treated to prevent progression of the condition.
Surgery is the best treatment for congenital scoliosis
Surgery is the primary treatment for congenital scoliosis and is the only effective treatment for patients with high growth potential and rapid progression of the deformity.
When is the right time to have surgery?
The timing of surgery for congenital scoliosis is generally better as soon as possible, depending on the child’s physical condition, the combination of other organ system abnormalities, and the experience and skill of the surgeon.
Surgical intervention for congenital scoliosis is best performed early to reduce the number of vertebral levels that need to be treated. Early surgery involves hemivertebral resection to remove the abnormal vertebrae, allowing the spine to straighten almost completely, and allowing the adjacent spinal segments to grow normally. In more complex congenital anomalies, multiple levels of fusion at the front and back of the spine may be required. In other cases, growth rod surgery may be required with the goal of preventing severe deformities from interfering with lung development or function, providing comfortable balance in the spine and maximizing growth and development in young children.