Congenital Scoliosis & Spinal Deformities
What is Congenital Scoliosis (CS)?
(CS) is a spinal deformity that is caused by vertebrae that are not formed properly during the development of children and adolescents. This condition arises from a defect that is present at birth, and it results in the sideways curvature of the spine. Thankfully, this condition is quite rare. In fact, (CS) occurs in only 1 in 10,000 newborns, which makes it much less common than other forms of scoliosis.
Presently, genetic studies and examinations of family history have shown that it is not likely for (CS) to be inherited. Instead, risk factors mostly involve defects in vertebra formation that occur prior to birth.
Causes of Congenital Scoliosis (CS)
(CS) can be caused by the following defects during a baby’s development:
- Spinal bones not forming properly
- Partial formation of spinal bones
- Bones not separating as normal
- Absence of one or more bones in the spine
Although (CS) can start prior to birth, it is often difficult to see any problems until a child reaches a certain age. Children with (CS) may also show other health issues, such as bladder and/or kidney problems.
Types of Congenital Scoliosis (CS)
In addition to the main scoliotic curve, a child’s spine may also curve in the opposite direction in other areas in order to maintain an upright posture. This is the result of the spine trying to make up for the (CS) curves by curving in the opposite direction below or above the affected area.
Failure of Separation
During development, the spine forms as a single column of tissue that is later separated into discs. If this does not happen as normal, it may result in two or more vertebrae fusing together. This can prevent the spine from growing on one side after the child is born, which results in a spinal arc that becomes progressively worse.
Sometimes, spinal bones may not form completely before birth. This can lead to bones with sharp angles in the spine which often get worse as the child grows. This can occur at one or multiple places in the spine. Sometimes, when there are multiple partial-discs, they can balance each other out and make the spine more stable as a result.
Combination of Hemivertebrae and Bars
Growth problems can occur when a bar on one side of the spine and a hemivertebra are combined. (A hemivertebra occurs when only one side of a vertebral body forms during development. A bar refers to the failure of vertebrae to separate) When this happens, scoliosis surgery is required at an early age to stop the condition from worsening.
How Do I Know If I Have The Symptoms of (CS)?
Even though (CS) is present at birth, symptoms are not easily detected until the child becomes older. Additionally, (CS) gets worse the longer it is left unattended.
Normally, (CS) is diagnosed through patient history, physical examinations, and x-ray images. An examining doctor will look for the following:
- Unevenness: The shoulder blades, waistline, and hips are often at different heights. Ribs may also poke out more on one side of the body than the other. It may look like the child is constantly leaning to the side. In some cases, the limbs can be affected, causing malformations in the hands, arms, and feet.
- Neurological Problems: In some cases, problems with the spinal nerves can cause weakness, loss of coordination, and numbness. Disorders that commonly affect this system include cerebral palsy, spina bifida, and muscular dystrophy.
- Urological Problems: Because the kidneys are formed at the same time as the spine, there may be issues both here and with the bladder. Children with (CS) have a 25% chance of this occurring.
- Heart Conditions: As with the kidneys, the heart also forms at the same time as the spine. As a result, a child with (CS) has a 10% chance of having an issue in this system as well.
- Other Problems: Children with (CS) may also have dimples or hairy patches on the skin of their back. Other problems with muscles, bones, or joints may appear as well. Though (CS) is not often described as painful, a child may experience pain in the lower limbs. Sometimes, scoliosis patients will also report difficulty hearing.
If you think your child has any of the above symptoms, it is strongly recommended to seek consultation from your healthcare provider.
How Dr. Lowenstein Can Help
(CS) can be treated in a variety of different ways, both surgically and nonsurgically. The type of treatment that your child receives will be based on the type of condition, the severity of the problem, and any other health issues your child has. These factors will allow your doctor to determine which treatment option is best for your child.
A child with a small, unchanging curve will be observed to make sure that their condition is not becoming worse. While this doesn’t happen in every patient, (CS) curves can get larger as the child grows. The younger the child is, the more likely the curve will worsen, as younger children still have more growing to do. Usually, observations by your doctor will be made over a 6-12 month period using x-ray imaging.
Although casts and braces are not effective in treating (CS), they may sometimes be used to control the compensatory curves in other areas of the spine.
Surgical treatment is typically reserved for patients with more severe conditions. Such conditions are characterized by the severity of the curve, large deformities in the spine, neurological problems, and the worsening of the condition over time.
The main goal of surgery is to allow the chest and spine to grow as much as they possibly can. For surgery, there are several options:
- Spinal Fusion: Vertebrae are fused together so that they heal into a single bone. This helps to stop abnormal growth and it prevents the curve from getting worse.
- Growing Rod: Rods are inserted into the body that can be lengthened with minor surgery every 6 to 8 months. Growing rods correct the curve while also allowing continued growth. In this procedure, one or more rods may be attached to the spine below and above the curve. As the child grows, the rod is lengthened via surgery to keep up with growth. Once the child has finished growing, the rod(s) are replaced and a spinal fusion is performed.
- Rehabilitation: Young children often recover quickly from surgical procedures and are discharged from the hospital within 7 days. Sometimes, a child may need to wear a brace or a cast for several months. After the child has recovered, they can return to most of the physical activities that they had previously enjoyed.
- Hemivertebra Removal: Partial vertebra can often be surgically removed. Metal implants are then used to maintain the partial correction of the curve. In this procedure, only two to three vertebrae are fused together.
If you live near Morristown, New Jersey and you have (CS), then don’t hesitate to contact Dr. Lowenstein. Dr. Jason E. Lowenstein is a fellowship-trained, board-certified spinal deformity & scoliosis surgeon with over 10 years of surgical experience.
When your child is initially diagnosed, there is no telling how the spinal deformity will progress. That being said, there are still signs that doctors can read to evaluate your child’s condition. In the thoracic region, anomalies often worsen with the growth of the patient. When multiple partially-formed vertebrae are located on the same side of the spine, the curve tends to progress with spinal growth. A fused vertebra opposite of a hemivertebrae is likely to cause curve progression over time. Because the most rapid growth spurts occur during the first 5 years of life and during adolescence, (CS) must be monitored most closely during these times. The outcomes of the condition depend highly on the progression of your child’s curvature and early intervention.