Congenital Scoliosis

Classification

Scoliosis surgeons may refer to the spine anomaly as either “failure of formation” or “failure of segmentation” (see Figure 1A). “Failure of formation” means one or more vertebrae became partially or fully triangular when viewed on a front and/or side X-ray. The abnormally shaped vertebra may cause a wedge in the front, back, or either side, or a combination, tilting the spine at that level. Regular X-rays are limited because they only show a two-dimensional representation of a three-dimensional problem. The other major type of malformation is “failure of segmentation”. This means that one or more vertebrae are abnormally connected together on one side. This connection will slow growth on the connected side while the unconnected side continues to grow. Your scoliosis surgeon will often will use descriptive terminology to designate how much growth potential may be in the congenital anomaly.

Figure 1A&B:

In the thoracic (chest) part of the spine, congenital anomalies of the ribs often correspond with the congenital anomalies of the vertebra. For example, an extra thoracic vertebra might attach to an extra rib. Vertebrae that are connected together may be associated with ribs that are connected together. The anomalies of the ribs and vertebrae are not always identical, but are often similar. At times the spine is tethered by a fusion of the ribs alone. This may lead to thoracic insufficiency syndrome if the chest cavity cannot grow properly. Furthermore, a child with congenital spine anomalies often has more than one. There can be a mix of wedged and connected vertebrae. At times the malformations can correct the deformity [a wedged vertebra (hemivertebra) on the left side and another on the right (see Figure 1B)]. Other times, multiple anomalies can accentuate the curvature (two same-sided hemivertebra on the same side). It is not uncommon that wedges on opposite sides of the spine cancel out the deformity. Therefore, the presence of malformed vertebrae is not a problem unless they cause the spine to tilt significantly out of alignment.

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