Evaluation and prognosis: After the history and physical examination, the next step in the evaluation of congenital scoliosis is to perform an X-ray. Good quality anteroposterior and lateral x-rays are necessary, and cervical spine x-rays are required to determine the presence of anomalous vertebrae; CT and 3-D reconstruction can clearly visualize congenital anomalies (this is usually part of the preoperative plan), and MRI is better at showing the features of the deformity and the presence of spinal cord deformity. In children younger than three months of age (before the vertebrae ossify and harden), ultrasound can be used to scan for spinal cord abnormalities without sedation. The pediatric spine surgeon may recommend that your pediatrician perform ultrasound of the kidneys and heart because the heart and kidneys are formed at the same time as the vertebrae, and factors affecting the spine may also affect other organs at the same time. Children with congenital scoliosis have a 25% chance of having urinary tract (kidney, bladder) or 10% chance of having cardiac system abnormalities, and the extremities should be examined for musculoskeletal deformities such as deformed feet or deformed arms.