Congenital scoliosis is a condition where abnormal lateral curvature of the spine appears in newborn children. It occurs due to issues with the development of vertebrae during early fetal development (between the 4th and 8th weeks). This abnormal development can lead to incomplete formation or failure of separation of one or more vertebrae, resulting in congenital scoliosis. Often, there may be accompanying abnormalities in the spinal cord (41%), heart (7-12%), or kidneys (20%).
In the classification of scoliosis, congenital scoliosis is the second most common type after idiopathic scoliosis, with a frequency of about 1-4% in the general population.
Various factors can contribute to congenital scoliosis, including infections during pregnancy, vitamin and mineral deficiencies, maternal diabetes, cardiac diseases, hyperthermia, alcohol use, and valproic acid poisoning. Additionally, congenital scoliosis can be associated with other congenital diseases.
Structural defects play a significant role in causing congenital scoliosis. For example, a pyramid-like half vertebra between other vertebrae can cause the spine to bend and form scoliosis. Problems in the ribcage, where ribs attach to each other, can also lead to asymmetrical growth of the vertebral column and congenital scoliosis.
Early diagnosis is crucial as congenital scoliosis tends to be progressive. Parents should consult a doctor if they notice any differences in the baby's neck, back, or waist. Timely treatment during early ages may require surgical intervention.
Monitoring the curvatures is essential for the success of therapy. The treatment approach depends on factors such as the degree and location of the curvature, the patient's age, and the presence of accompanying kyphosis or lordosis. Regular monitoring, including X-ray imaging, helps track the progression and allows for timely intervention if required.
For congenital scoliosis patients with long curvatures encompassing a large section of the spine, brace treatment might be beneficial, especially for treating secondary curvatures. However, brace treatment is generally less successful for short and inflexible curvatures.
In progressive cases, surgical treatment is the most applied method. Surgical options include hemivertebra resection, controlling the curvature using growing rods, spinal fusion, and VEPTR (Vertical Expendable Prosthetic Titanium Rib) surgery.
Hemivertebra resection involves surgically removing the incomplete hemivertebra responsible for causing congenital scoliosis, preventing further curvature.
Using growing rods placed between the upper and lower ends of the scoliosis curvature, the correction can be achieved without spinal fusion. These rods are periodically lengthened, allowing for proper correction and growth until adulthood. A newer technique involves magnetically growing rods, which reduce the need for repeated surgeries.
Spinal fusion, on the other hand, involves fusing the vertebrae together to maintain the correction. This option is more suitable for young patients with a complete spinal development or adults.
For patients with scoliosis and rib abnormalities, VEPTR surgery aims to correct scoliosis and expand the rib cage, preventing lung failures. The rib cage is expanded, and a spinal fusion surgery is performed at the end of adolescence once sufficient rib cage volume is achieved.
In conclusion, congenital scoliosis requires early diagnosis and appropriate treatment based on the patient's age and the progression of the curvature. Regular monitoring is vital to ensure the best possible outcomes and prevent further complications.
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