OrthoNet

Cong. Scoliosis
Approach to Congenital Scoliosis

Failure of segmentation or formation, or both - patients with this often have BOTH.

Look for other intraspinal and extra-skeletal abnormalities

From worst to best: Unilateral unsegmented bar with contralateral hemivertebrae
Unilateral unsegmented bar
Fully segmented hemivertebrae
Partially segmented hemivertebrae
Incarcerated hemivertebrae
Unsegmented hemivertebrae

- note that the more segmentation of the hemivertebrae, the worse its prognosis

- bracing should be tried but is far less successful than in adolescent idiopathics
- should not wait too long before pulling the trigger on these - don’t allow them to develop a huge deformity before conceding and trying to do something

Surgery

- usually posterior fusion suffices - anterior crankshaft is not as big of a problem in this population because their anterior growth plates are usually not normal. But you should think of doing anterior fusion also in the very young.
- consider hemivertebrae excision (usually, a hemivertebrae can be managed with posterior fusion alone)