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
– 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
– 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)