Modern Approaches and Time-Tested Methods in Managing Congenital Scoliosis in Children

Congenital scoliosis encompasses a highly variable, heterogenous group of vertebral anomalies, the mere presence of which is not an indication for intervention; documentation of curve progression is a prerequisite for treatment. Initial evaluation should include investigations to diagnose concomitant genitourinary and cardiac anomalies primarily, and the morphology of the vertebral anomaly should be classified for prognostic purposes. Although sometimes considered only a delaying tactic, bracing treatment and casting can have definite value in controlling flexible congenital curves. Surgical options include prophylactic in situ fusion for the child with mixed vertebral anomalies involving ≤5 segments and a small curve. For young patients without coronal imbalance and ≤5 anomalous segments, a convex growth arrest/hemiepiphysiodesis can be effective for growth modulation, and it can be augmented with a concave growing rod, either traditional or magnetically controlled to improve balance and correction. Although traditional growing rod methods have been used for congenital scoliosis, crankshafting and adding-on may occur due to lack of apical fixation. Thus, apical control techniques have been recently added to traditional growing rod to minimize this cause of curve progression. Finally, an isolated hemivertebra excision with short segment fusion is a mainstay of treatment for progressive curves <50° in young children. In the more mature patient, generally at least 8 to 10 years old, a single definitive correction and fusion gives the most reliable outcomes.