For the treatment of children with congenital hemivertebral anomalies, the most important concerns of parents are: 1) whether surgery is needed; 2) when is the right time to do the surgery; 3) whether the risk is high; and 4) whether it will affect the growth of the child. According to MacEwen’s classification, congenital crestal deformity is divided into: type I for vertebral body formation disorders, such as cuneiform vertebrae and hemivertebrae; type II for vertebral body malsegmentation, unilateral malsegmentation and bilateral malsegmentation; and type III for mixed type, which has both type I and type II characteristics. It is easy to see from the typology that hemivertebral deformity is caused by vertebral body formation disorder, which can be further divided into: 1, single hemivertebral body without segmentation type, which generally does not develop and aggravate; 2, hemivertebral type, also known as double arch deformity, which can cause mild to moderate scoliosis deformity; 3, fully segmented hemivertebral body deformity, which has a functional epiphysis above and below with growth potential and can cause more severe scoliosis deformity of the crest. As you can see, the timing of surgery varies by subtype. So how old can a child be considered for surgery? Anatomical studies have shown that the development of the spinal canal is much better than the development of the vertebral body. At 1 week of age, the diameter of the spinal canal is already close to the size of the adult spinal canal, and the spinal canal morphology is basically fixed, so internal fixation with pedicle screws at 1 week of age will not result in developmental spinal stenosis. Moreover, the risk of anesthesia gradually decreases after 1 week of age, and the ability to tolerate surgery increases. In the literature, Ruf et al. reported 28 cases of congenital scoliosis with posterior hemivertebral resection at a mean age of 3 years and 4 months with good surgical results, and Lazar et al. reported a group of children with a mean age of 18 months with a 77% orthopedic rate and concluded that surgery before the age of 3 years was effective. In clinical practice, we tend to schedule surgery until 3 years of age or older, considering the better flexibility of children and the good results of scoliosis correction with skilled pedicle screw implantation techniques, although, of course, surgery should be performed as early as possible if progressive aggravation of hemivertebral deformity is detected. The surgical approach is posterior hemivertebral body resection + short segment pedicle screw fixation, which has the following advantages: 1. The hemivertebral body is located on the convex side of the top of the deformity, while the crestal medulla is close to the concave side, so there is enough space to remove the hemivertebral body and its upper and lower discs without pulling the crestal medulla under direct vision.