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Scoliosis
Congenital Scoliosis
Evaluation & Prognosis
Evaluation
Figure 1:
CT 3D reconstruction showing a
T12 “butterfly” vertebra (cleaved in
center) and right L3 hemi-vertebra.
After the history and physical examination, the next step in evaluating congenital scoliosis is obtaining X-rays. Good quality anteroposterior (front view) and lateral (side view) X-rays are necessary. X-rays should include the neck and thoracolumbar (shoulders-to-waist) spine. The three-dimensional structure of the abnormal bone(s) may be best visualized with CT scan because three-dimensional reconstructions of the spinal anatomy are possible
(see Figure 1). MRI is also valuable to rule out associated anomalies in the spinal cord, and better define the nerve and disc anatomy. In children less than 3 months (before the vertebrae ossify and harden), an ultrasound examination can scan the spinal cord for abnormalities without the need for sedation. Your scoliosis surgeon may also advise your pediatrician to obtain an ultrasound of the kidneys or a cardiology consult. Because the kidneys and heart are formed at the same time as the vertebra, something that affects the spine may affect other organs. Children with congenital scoliosis have a 25% chance of having and anomaly of the urologic system (kidneys, bladder) or 10% chance in the cardiac system. The child’s limbs should be examined for any musculoskeletal abnormalities, such as clubfoot or malformed hand or arm.
Prognosis
When your child’s congenital spine anomaly is first diagnosed, no one will know exactly how much the spinal deformity will progress as the child grows. There are some clues, however. Anomalies in the thoracic spine tend to progress more. Multiple fully-segmented hemivertebrae (triangular vertebra with discs between them) on the same side of the spine tend to progress more. A hemivertebra opposite a set of fused vertebrae (bar) is the most likely combination to progress as the child grows. Because of the rapid period of spinal growth in the first 5 years of life, and similarly during adolescence, curves must be monitored closely during these periods.
