Post on Congenital Scoliosis #4 2-27-2021
1. How much will the congenital scoliosis change with growth?
a. Plain radiographs and MRI may be able to predict spinal growth and the chance of developing a spinal deformity or its speed of progression (worsening) in some patients. This is more likely if there is a single area of abnormal vertebral development. If there is more than one location, then predicting spinal growth or the risk or progression of spine deformity becomes less and less precise.
Simple: Single Hemivertebra Complex: Multiple hemivertebra and bars
2. Will my child grow normally?
a. Half a person’s body height comes from their legs, the other half from their spine. If the child’s legs are normal, then the legs will grow normally, which is determined by their genetics.
b. The other half of a person’s height comes from their spine and head.
i. In congenital scoliosis the vertebra are abnormally developed and have altered growth. The vertebra affected will never grow normally. At present, we cannot make them grow normally, with or without surgery.
ii. It is typically difficult to prognosticate early in the child’s life the amount of spinal shortening or development of spinal deformity that will occur.
3. So, if the spine will never be “normal” height what will that mean for the child?
a. Their maybe some impact on the appearance of the child’s proportions between the body and the legs. The body may appear shorter and the legs longer, proportionally, when compared to other children.
b. The most significant issue is this decreased growth is the lungs and smaller volume of the lungs. The lungs will not have the same space to grow maximally. The less vertical growth of the child, the less volume of the lungs will develop. Smaller lung volumes as a child don’t typically cause much impact, but in an adult can cause issues with breathing, respiratory infections, shortness of breath, etc....
3d reconstructions of lungs in a patient with congenital scoliosis
4. What can be done to maximize the growth of the spine and the lungs?
a. This is where it is crucial to work with a pediatric spine deformity surgeon closely.
b. It is important to identify the location of the congenital deformity and the type of congenital scoliosis, using plain radiographs, and sometime MRI.
c. Routine, scheduled follow-up with spine radiographs is essential. Changes in the spine usually are difficult to see with your eyes alone. Radiographs are essential to follow to identify the development of spinal deformity (scoliosis, kyphosis or both), and its progression.
d. If there is a low magnitude (small) of the spine deformity, and it doesn’t progress/worsen, then observation is typically recommended. This is ideal.
e. However, if there is a high magnitude (big) deformity and/or there is significant progression then an intervention/treatment is often the best option.
f. It is important to remember that every child and spine deformity is unique. The pediatric spine deformity surgeon must look at the entire child, not just the spine problem to optimize treatment recommendations. This means some treatments and surgeries may be preferred in some children, but not others.
5. So if the child has a large magnitude congenital scoliosis and/or it is significantly progressing, what are the treatment options?
Large magnitude curve
a. In general, the main nonsurgical option is observation. The prevailing opinion amongst pediatric spinal deformity surgeons is that bracing does not change the natural history of the congenital scoliosis. I agree with this perspective. However, sometimes casting and bracing may be an option to guide the growth of the “normal” part of the spine.
Casting of 3 year old with congenital scoliosis
b. The other treatment option is surgery.
Next week’s blog post will discuss surgical options for congenital scoliosis.