Congenital scoliosis is a spinal deformity caused by abnormal vertebral development during embryonic development, and can be described as a form of scoliosis brought from the womb, mainly divided into vertebral malformations (most commonly hemivertebral), vertebral malsegmentation, and a mixture of both. Although congenital scoliosis is present at birth, not all patients are born with severe scoliosis, or many patients are discovered only after they grow up. This is because babies are born and grow to adulthood through two growth spurts, one between the ages of 0 and 3 and the other during adolescence. Due to vertebral developmental deformities, the human spine grows asymmetrically on both sides, with one side growing faster and the other slower, and scoliosis grows bigger and bigger and becomes obvious, and is only “discovered” at this time, especially during the two growth spurts that are most likely to worsen. Not all congenital scoliosis progresses to the point of requiring surgery, but the key depends on the rate of growth imbalance between the two sides. The famous American Professor Winter once did a good study of the natural course of the disease and found that 25% did not develop, 25% developed mildly (<30°), and 50% developed significantly (>30°). Spine surgeons need to identify the type of congenital scoliosis and make reasonable judgments about the trend of its development in order to treat it well. The current general principle of treatment for congenital scoliosis emphasizes early detection and early treatment, but the timing of surgery should be both aggressive and cautious. The phrase “actively and carefully” sounds a bit contradictory, why is that? Congenital scoliosis is early-onset scoliosis (scoliosis that occurs before the age of 10), which is not only a deformity of the spine, but may also affect the development of the thorax and lungs, so the treatment of congenital scoliosis should not only control the spinal deformity, but also minimize the impact on the growth and development of the spine and the development of the thorax and alveoli. Currently, for hemivertebral deformities, a category of congenital scoliosis with predominantly localized deformity and short involvement, early surgical removal of the hemivertebral body to remove the causative factors is advocated if a poor natural history is expected or if there is significant deformity progression during observation. Early surgical resection is recommended for non-integrated hemivertebrae (especially fully segmented), lumbosacral hemivertebrae, posterior hemivertebrae, and hemivertebrae with poor contralateral segmentation for poor natural history, along with the shortest possible fixed fusion to preserve more spinal growth and motor function and reduce the impact on thoracic and pulmonary development. Generally speaking, the timing of surgery is more appropriate at the age of 3-5 years. At this age, the child is able to cooperate, and anesthesia and nursing care are relatively easy; the child’s bone condition is better, and he or she can choose a suitable internal fixation. Of course, if the deformity is already very obvious before the age of 3, surgery can be performed in time after the age of 1. When the congenital spinal deformity is more complex and involves more segments, a “delay” strategy is required. If the progression of congenital scoliosis is expected to be rapid, treatment with a cast or brace can be performed. Although a cast or brace cannot control short-segment angular congenital scoliosis, it can temporarily control soft long-segment deformities or compensatory scoliosis above and below them; if it is difficult to estimate the developmental trend, observation can be performed first, and then treatment can be performed after the developmental trend. treatment. So the delay here is to gain time for the development of the spine, thorax and lungs, which is a positive wait. There are 2 time points to delay here, one is 5 years old and the other is 10 years old. after the age of 5 years old, you can consider the growth rod technique, which can correct spinal deformity while preserving spinal or thoracic growth, but the disadvantage is that it requires regular bracing, multiple surgeries, usually once every 6-9 months, and eventually fusion surgery. After the age of 10, a one-time orthopedic spinal fusion can be considered, avoiding the need for multiple surgeries. Treatment of congenital scoliosis is difficult, but it is important to remember several important concepts. First, not all congenital scoliosis requires surgery; second, congenital scoliosis with a poor natural history requires early intervention, and early intervention means not only surgery, but also observation, plaster, and brace treatment; third, congenital scoliosis is not only a cosmetic deformity, but may also affect the spine, thorax, and lung Third, congenital scoliosis is not only a cosmetic deformity, but may also affect the growth and development of the spine, thorax, and lungs.