Congenital Scoliosis

Congenital scoliosis is a sideways curvature of the spine that is caused by a defect that was present at birth. It occurs in only 1 in 10,000 newborns and is much less common than the type of scoliosis that begins in adolescence.

Children with congenital scoliosis sometimes have other health issues, such as kidney or bladder problems.

Even though congenital scoliosis is present at birth, it is sometimes impossible to see any spine problems until a child reaches adolescence.

Types of Congenital Scoliosis

A single hemivertebra in the lower back shown in a 3-D image from a computed tomography (CT) scan. Note the four normal rectangular vertebra below the single triangular-shaped hemivertebra (arrow). This wedged vertebra creates the deformity that would not have otherwise been there.

Incomplete Formation of Vertebrae
As the spine forms before birth, part of one vertebra (or more) may not form completely. When this occurs, the abnormality is called a hemivertebra and can produce a sharp angle in the spine. The angle can get worse as the child grows.

This abnormality can happen in just one vertebra or in many throughout the spine. When there is more than one hemivertebra, they will sometimes balance each other out and make the spine more stable.

Failure of Separation of Vertebrae
During fetal development, the spine forms first as a single column of tissue that later separates into segments that become the bony vertebrae. If this separation is not complete, the result may be a partial fusion (boney bar) joining two or more vertebrae together.

Such a bar prevents the spine from growing on one side after a child is born. This results in a spinal curve that increases as a child grows.

Combination of Bars and Hemivertebrae
The combination of a bar on one side of the spine and a hemivertebra on the other causes the most severe growth problem. These cases can require surgery at an early age to stop the increased curvature of the spine.

Compensatory Curves
In addition to scoliosis curves, a child's spine may also develop compensatory curves in order to maintain an upright posture. This occurs when the spine tries to make up for a scoliosis curve by creating other curves in the opposite direction above, or below, the affected area. The vertebrae are shaped normally in compensatory curves.

Symptoms

Congenital scoliosis is often detected during the pediatrician's examination at birth because of a slight abnormality of the back.

Scoliosis is not painful, so if the curvature is not detected at birth, it can go undetected until there are obvious signs -- which could be as late as adolescence. A child may suspect that something is wrong when clothes do not fit properly. Parents can discover the problem in early summer when they see their child in a bathing suit.

The physical signs of scoliosis include:

• Tilted, uneven shoulders, with one shoulder blade protruding more than the other
• Prominence of the ribs on one side
• Uneven waistline
• One hip higher than the other
• Overall appearance of leaning to the side
• In rare cases there may be a problem with the spinal cord or nerves that produces weakness, numbness, or a loss of coordination.

Contact Parkland's spine specialists to receive comprehensive evaluation and management for spine problems.