60 Post on Congenital Scoliosis                                1-17-2021          

 

Frequently-Asked Questions about congenital scoliosis

 

1.      Why does it happen? Unfortunately we don’t know

2.      When does it happen? In utero when the fetus is very, very small and is very early in its development.

3.      What other problems can be associated with congenital scoliosis?  There are three other organ systems which have high abnormality rates in patients with congenital scoliosis: heart, kidney and spinal cord.  The theory is that during development something happens at one time point during development that can cause the congenital scoliosis and the other heart, kidney and spinal cord problems.

4.      How often are these other problems present? In 2019 we published a study looking at this very problem.  We reported on 305 patients from Shriners Hospital, St. Louis and St. Louis Children’s Hospital over a 25-year time span who had congenital scoliosis.  Our patient population 54% had a heart anomaly, 43% had spinal cord anomaly and 39% had a urogenital (kidney, bladder, etc…) anomaly.

5.      How to we check for these heart, kidney and spinal cord problems? Many patients have already had the imaging studies to check for these problems.  If not, then we need to assess if additional imaging studies are necessary. 

6.      What are the imaging studies to look at the heart? For the heart we order an echocardiogram, a painless study which looks at the heart function and for any small holes in the heart or valve problems.

7.      What is the imaging study for the kidneys? Renal ultrasound

8.      What is the imaging study to study the spinal cord? MRI (magnetic resonance imaging) scan of the entire spinal cord, from the brain to the sacrum).

This child has a spinal cord syrinx, which is a fluid-filled dilation of the spinal cord, and a Chiari malformation.

9.      Do we always get all three of these studies, for every patient? Not always.  We are more likely to get these imaging studies in the younger patients, if they have not already been obtained.  In the older patient, say in adolescence, we may not get an echocardiogram or spinal cord MRI.  This is because if they have been followed for many years by their primary care physician (who looks at them annually for school physicals) and they are not having any symptoms related to the heart or spinal cord, the likelihood of finding something wrong is very, very low.

10  What happens if something abnormal is found on one of these three imaging studies? It depends.  We usually consult other specialists as to the need for further evaluation or follow-up (kidney, urologists; spinal cord, neurosurgeon; heart, cardiology).

      More on congenital scoliosis next week.....