CONGENITAL SCOLIOSIS

Causes of Congenital Scoliosis

Congenital scoliosis is a spinal deformity present at birth caused by vertebral anomalies that develop in the womb. These anomalies occur when the vertebrae fail to form properly, leading to partial or complete absence of vertebrae, vertebrae that are wedge-shaped or fused together, or extra vertebrae. The exact causes of these developmental issues are not entirely understood but scientists believe the condition is linked to genetic factors and environmental influences during pregnancy. Some researchers suggest that disruptions in the genes responsible for spine development or exposure to harmful substances, such as certain medications or environmental toxins, during critical periods of fetal development could play a role.

Additionally, congenital scoliosis is often associated with other congenital abnormalities affecting various systems, including the heart, kidneys, and nervous system. These coexisting conditions may arise from the same developmental disruptions that affect the spine. Early diagnosis and careful monitoring of congenital scoliosis are crucial to managing the condition effectively. Treatment may involve bracing, physical therapy, or surgical intervention, depending on the severity of the curvature and the presence of any associated health issues.

Causes and Types

The exact cause of congenital scoliosis is often unknown. However, genetic factors and environmental influences during pregnancy are believed to cause the condition. Some common types of congenital scoliosis include:

• Hemivertebrae: One side of a vertebra fails to develop, creating a wedge-shaped bone.
• Unsegmented vertebrae: Two or more vertebrae fail to separate, resulting in a fused block of bone.
• Block vertebrae: Two or more vertebrae completely fuse together.

Symptoms 

• Tilted, uneven shoulders, with one shoulder blade protruding more than the other
• A rotation of the neck causes the head to tilt in one direction
• The prominence of the ribs on one side
• Uneven waistline
• One hip higher than the other
• An overall appearance of leaning to the side
• A problem with the spinal cord or nerves that causes weakness, numbness, or a loss of coordination in rare cases

Diagnosing Congenital Scoliosis

In order to diagnose congenital scoliosis, the doctors at Southwest Scoliosis and Spine Institute will look carefully at the child’s medical history and perform a thorough physical examination. The following provides a list of the methods our doctors use:

• Medical History and Physical Examination: The doctor begins by taking a detailed medical history, including information about the patient’s birth, developmental milestones, and any family history of scoliosis or other spinal conditions. They will conduct a thorough physical examination, observing the patient’s posture, and assessing shoulder and hip levels, and the spine for abnormalities.
• Imaging Studies: X-rays are typically the first-line imaging study used to evaluate spinal deformities. They provide detailed images of the spine, allowing the doctor to measure the curvature angle, identify the specific vertebrae affected, and assess the overall severity of the scoliosis. Technicians can take X-rays in various positions to better understand the flexibility of the spinal curve. We use a 3D low-radiation EOS X-ray machine that offers significant advantages in the field of medical diagnostics — particularly in orthopedics and spine imaging.
• Additional Imaging: In some cases, doctors will order additional imaging studies for a more comprehensive evaluation. These may include magnetic resonance imaging (MRI) scans or computed tomography (CT) scans. These imaging modalities provide more detailed information about the spinal anatomy.
• Evaluation of Associated Conditions: Our doctors associate congenital scoliosis with other congenital abnormalities affecting other organs or systems. Therefore, the doctor may conduct additional tests or consultations with other specialists, such as cardiologists or geneticists, to assess the patient for any associated conditions.

Treatment 

The treatment options for congenital scoliosis depend on various factors, including the severity and progression of the curvature, the age of the patient, and the presence of associated spinal abnormalities. Here are some common treatment approaches:

Curves less than 25 degrees

For curves less than 25 degrees, we recommend ongoing monitoring by our orthopedic physicians.  If our doctors, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD find that the child’s spinal curves are worsening, the doctors may suggest spine bracing. “Because bracing reduces the pressure on your child’s lower back, bracing helps straighten your child’s spine.  Thus, the ultimate treatment goal is to prevent the curve from progressing,” states Dr. Hostin.

• Observation and Monitoring: Doctors can manage mild cases of congenital scoliosis that are not rapidly progressing through regular observation and monitoring. The doctor will regularly assess the spinal curvature through physical examinations and imaging studies to track any changes. This approach often takes place with infants and young children who are still growing.

25 to 40-degree Curves

For children with curves between 25 and 40 degrees, the recommended treatment will depend on your child’s individual circumstances. “For example, either spine bracing or spinal surgery may provide the appropriate treatment for your child,” explains Dr. Kishan.

• Bracing: Our doctors recommend bracing for moderate scoliosis curves that have the potential to worsen during periods of rapid growth. The brace helps to prevent further progression of the curve by providing external support to the spine. The type and duration of bracing will vary depending on the individual case. Also, the patient may need periodic follow-up appointments to monitor the effectiveness of the brace.
• Surgery: Severe cases of congenital scoliosis, or those that significantly affect the patient’s quality of life may require surgical intervention. Our doctors consider surgery when everything else has failed to correct the spinal deformity, stabilize the spine, and prevent further progression. Surgical techniques vary depending on the specific spinal abnormalities and may involve spinal fusion.  In some cases, we use instrumentation (such as rods, screws, or wires), or a combination of these approaches. The surgical plan is tailored to the individual patient’s needs and is typically conducted by a specialist in pediatric orthopedic or spine surgery.

It’s important to note that the treatment plan for congenital scoliosis is highly individualized. Regular consultations with doctors like us who specialize in spinal disorders will help determine the most appropriate treatment approach. We base our findings totally on the specific characteristics and needs of the patient.

Congenital Scoliosis Surgery

For congenital scoliosis, the most common surgical treatments are implanting growing rods and spinal fusion. However, the determination of which surgery is right for your child will depend on your child’s age and skeletal maturity, After the initial determination, our doctors will consider a host of other medical considerations.  Above all, our Scoliosis Doctors will take the time to review all the options with the parents.  We want the parents to make an informed decision based on the knowledge we provide to them.

“Because It’s a serious surgery, it’s critically important that we sit down with patients and their families to explain the risks and benefits of each procedure,” Dr. Hostin explains. “Furthermore, I spend significant time in preoperative conversations discussing the risks, the benefits, the possibilities, and what my own personal experience has been over the last 15 years.  Therefore, my goal is to make sure the parent has a complete understanding of the risks and the intended outcome.”

Finally, if your child has other health issues — such as heart, lung, or kidney problems — our orthopedic team works with experts in these disciplines to ensure your child gets the comprehensive care they need.

Enhanced Precision in Complex Spinal Surgeries

Computer-assisted navigation plays a critical role in ensuring accuracy during spinal surgeries. By utilizing advanced imaging technology and real-time feedback, surgeons can navigate the complex anatomy of the spine with enhanced precision. This technology is particularly crucial in challenging surgical scenarios where the spine exhibits significant abnormalities, such as a high degree of rotation and pedicle dysplasia.

In such intricate cases, computer-assisted navigation is instrumental in the precise placement of surgical instruments. For instance, it allows for the safe placement of multiple screws in the apex of the curve to maximize the surgical reduction. This targeted approach is essential in managing complex spinal deformities effectively, where every millimeter counts for a successful outcome.

Moreover, computer-assisted navigation helps in identifying the exact location for spinal instrumentation placement.  This reduces the risk of errors and improving overall surgical outcomes. Additionally, this technology facilitates minimally invasive approaches.  This leads to smaller incisions, less tissue damage, and quicker recovery times for patients undergoing spinal surgery.

By integrating precise technology with surgical expertise, computer-assisted navigation enhances the safety and efficacy of spinal surgeries, providing significant benefits in both complex and routine procedures.

Recovery

Recovery time for a child after congenital scoliosis surgery varies based on several factors, including the child’s overall health, the complexity of the surgery, and the specific surgical techniques used. Generally, initial recovery in the hospital takes about one week, during which the child is monitored for complications and begins the healing process.

After being discharged, the child typically requires several weeks to a few months to recover at home. During this period, the doctor will limit activities to allow the spine to heal properly. Full recovery, including the return to normal activities and sports, can take anywhere from six months to a year. Physical therapy and follow-up visits with the surgeon are often part of the recovery process to ensure proper healing and to monitor the spine’s alignment.

Conclusion

Parents should choose to seek treatment for a child with congenital scoliosis from specialized centers. Our practice offers expertise in the diagnosis and treatment of this condition. The Southwest Scoliosis and Spine Institute with offices in  Dallas, Plano, and Frisco, Texas offers a multidisciplinary approach to treatment.  This Spine practice involves a team of specialists, including orthopedic surgeons, physical therapists, and pain management specialists. Additionally, the Southwest Scoliosis and Spine Institute offers access to advanced diagnostic tools and treatment options.  For instance, this practice uses minimally invasive spine surgery and spinal fusion. Patients may also benefit from a personalized treatment plan that takes into account their unique needs and medical history. Ultimately, the decision to seek treatment at a particular medical institution will depend on various factors, but for those wanting to get the very best, parents should consider the Southwest Scoliosis and Spine Institute as their first choice.

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BirthDefects.org: Congenital Scoliosis