Congenital Scoliosis

Question 1

Congenital Scoliosis

Answer 1

Caused by anomalous vertebrae
Do not confuse with infantile IS (does not have anomaly)

Clinical manifestations may not be present at birth, but anomaly is present

Anomaly can be attributed to:

• failure of vertebral segmentation
• mixed defect
• or combo of the two
• Usually both are seen in the same spine and may occur at the same or different levels
• Location determines congenital deformity
• – Purely lateral = congenital scoliosis
• – Anterolateral and posterolateral = kyphoscoliosis or lordoscoliosis

M:F = 1: 1.4

Question 2

Defect of Segmentation

Answer 2

Often seen in adjacent vertebrae that do not completely separate from each other = produces and unsegmented bar without growth plate or disk btwn vertebrae

Lateral, one sided defect of segmentation = severe progressive congenital scoliosis

Circumferential failure = en bloc vertebrae = results in loss of segmental motion and loss of longitudinal bone growth, does not have a rotational or angular spinal deformity

Question 3

Defects of Formation

Answer 3

Partial or Complete

Anterior failure of all or part of vertebrae = kyphosis

Partial unilateral defect of formation of vertebrae = wedge shaped hemivertebrae with only one pedicle and one side with growth potential

Non-segmented hemivertebrae = completely fused to adjacent proximal and distal vertebrae

Semi-segmented hemivertebrae = fused to only one adjacent vertebrae and is separated from the other by a normal end plate and disc

Segmented hemivertebrae = separated from proximal and distal vertebrae by a normal end plate and disc

Hemivertebrae may be:

• • Unbalanced = with defect only present on one side of the spine
• • Balanced = different hemivertebrae present, with defects on opposite sides of the spine compensating for any curves

Question 4

Abnormalities Involving Other Organ Systems

Answer 4

Found in 61% of patients with CS

Organ systems develop while sclerotomes are differentiating to form vertebral bodies during embryonic period = any noxious stimuli affecting formation of vertebral growth will also effect development of organs

Cardiac anomalies have been associated with CS of thoracic spine

Kidney anomalies have been associated with lumbar scoliosis

Question 5

Spinal Dysraphism

Answer 5

Incidence is high in patients with CS- 40%

Clinical Signs = hair patch, unequal foot size, various foot deformities, asymmetrical le circumference and strength

Other associated defects = urinary tract anomalies, hearing deficits, facial asymmetries, Sprengels deformity (undescended scapular = webbing or shortening of neck and limited shoulder ROM)

Question 6

Risk of Curve Progression

Answer 6

Can bet determined by congenital anomaly and growth potential

Many CS become stable and do not progression

Highest risk of progression occurs when assymmetrical growth occurs with the convexity outgrowing the concavity —> occurs when anatomy of the convex side is relatively normal and the concave side is deficient

Shortened trunk may be main deformity of convex and concave growth deficiencies occur over multiple levels.