Congenital scoliosis

Congenital spinal anomalies with associated deformity are challenging problems as the natural history can be highly variable and surgery, if required, is performed in the face of a rapidly growing spine and thorax. Three-dimensional CT has been recognized as an indispensable diagnostic tool and has improved preoperative planning for the often complex three-column deformity. Classic surgical interventions of in-situ fusion or acute correction with instrumentation continue to be the mainstay of treatment for progressive deformity in congenital scoliosis. Newer techniques gaining popularity include vertebral column resection for severe kyphotic deformity in typically neglected cases and hemivertebra resection through a single posterior approach with instrumented correction. Importantly, recent recognition of chest wall deformity independent of spinal deformity and a possible association between early fusion and restrictive lung disease has resulted in the use of growth-modulation techniques such as growing rods and rib-expansion implants. As the understanding of the growing spine and the relationship of adult pulmonary function with spinal height progresses, treatment options for this unique patient set will continue to evolve.