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 four to six weeks of gestation. It is present at birth and may be associated with other health problems such as kidney or bladder diseases. To learn more about this type of scoliosis, contact Children's Orthopaedics of Atlanta. We are here to help!
Causes & Symptoms
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 – An unsegmented bar on one side of the spine and a hemivertebra on the other result in an increased curvature of the spine.
- Compensatory curves – During this condition your child’s spine will create other curves in the opposite direction above or below the affected area, so as to make up for the scoliosis curve. The vertebrae appear normal in shape.
This condition is usually noticed because of a slight back abnormality. Other physical signs include:
- Uneven shoulders
- Uneven waistline
- One hip higher than the other
- Overall appearance of leaning to one side
Congenital scoliosis is usually detected at the time of birth. A pediatrician often notices a slight back abnormality. Common diagnostic testing can confirm diagnosis.
- X-ray - can disclose the abnormal vertebra
- MRI scan - check for the abnormalities of spinal cord
- CT scan - show a detailed image of the spine
- Ultrasound scan - can detect any problem that has affected your child’s kidneys
Non Surgical Treatment
Observation of the child at 4 to 6 months intervals
If the child has small curves and balanced patterns of malformation, then the impact can be minor and no treatment could be required. Your doctor will observe these changes by X-rays, which are taken during the period of rapid growth.
Braces or casts
Sometimes braces or casts can be used to control the compensatory curves that are adjacent to the congenital abnormality of vertebra to prevent them from worsening.
First, it involves the removal of the abnormal vertebra and replacing with bone grafts. Then, 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.
In this procedure, the hemivertebrae or abnormally shaped vertebrae are removed. Then, the vertebrae 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 will wear a cast or splint to prevent movement and bring about fusion of vertebra.
Growth Rod Insertion
Often, spinal fusion surgery will not be effective in a child that is still growing and could cause impairment of the chest and growth of the lungs. Therefore, your doctor might recommend insertion of growth rods before going for surgery. 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. At that time, spinal fusion surgery can then 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. Then, internal fixators, such as metal rods, hooks, screws, and wires, will be used to restore the balance of the spine.
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. Then, they will design exercises to help control pain and improve your child’s disability.