Congenital Scoliosis in Children : Classification,Treatment

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Dr A.Johari.
Consulting Pediatric Orthopedic
Consultant at Bombay Hospital ,
B.J.Wadia Children's Hospital ,
Children's Orthopedic Centre.

Q. What is congenital scoliosis ?

A.Congenital Scoliosis results from defective unilateral segmentation or formation. This is often associated with absence or fusion of ribs. Associated anomalies may be present in the form of a 20% incidence of genito-urinary anomalies and 7% incidence of congenital heart disease. Diastematomyelia occurs in 5% of the cases.

Congenital scoliosis are classified by MacEwen as :

Failure of formation
- Partial failure of formation - wedge vertebrae.
- Complete failure of formation - hemivertebrae.
Failure of segmentation
- Unilateral failure of segmentation - unilateral unsegmented bar.
- Bilateral failure of segmentation - block vertebrae.
Miscellaneous
Unsegmented bar and multiple hemivertebrae adjacent to one another on the same side are responsible for the progressive curves. The greater the curves in terms of degrees and longer the curve in terms of number of vertebral segments involved, the more likely the curve will progress.

Treatment consists of

Non - operative treatment: Bracing (e.g. Milwaukee brace) is effective. It is primarily used for the more flexible secondary curves below the congenital one. If the brace maintains the curve in an acceptable position, it is continued. If the curve deteriorates despite faithful brace wearing, fusion is indicated. Bracing is not effective in curves exceeding 50 degrees.
Operative treatment: A progressive curve must be treated surgically at a very young age. The various options are:
- Fusion in situ
- Cast / halo pelvic correction with fusion
- Epiphysiodesis to prevent growth on the convex side with fusion.

REFERENCES:

Evarts MC. Surgery of the musculo-skeletal system. Churchill Livingstone, 2nd Edition, 1990.
Cauthen JC. Lumbar spine surgery. Williams and Wilkins, 1st Edition 1983.
Sharrard WJW. Pediatric orthopaedics and fractures. Blackwell Scientific Publications, 3rd Edition, 1993.
Moe JH, Winter RB, Bradford et al. Scoliosis and other deformities. WB Saunders, Philadelphia, 1978.
Bunnell WB, MacEwen GD. Congenital deformities of the spine. Surgery of the musculoskeletal system, 2nd Edition, 1993, pp. 2005.
Tachdjian MO. Pediatric Orthopedics, WB Saunders, 2nd Edition, 1990.

Last created on 13-06-2001
Last updated on 01-07-2006

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