Congenital Scoliosis — Classification, Investigation and Management
DNB Orthopaedics • May 2024 • Paper IV • 10 Marks • [2+2+6]
Introduction
Congenital scoliosis is a spinal deformity resulting from abnormal vertebral development during embryogenesis, due to a defect of vertebral formation, segmentation, or a combination of both.
The abnormality develops early in fetal life, classically during the first 4–6 weeks of gestation, when vertebral formation and segmentation occur. Although the vertebral anomaly is present at birth, the spinal deformity may not become clinically obvious until later childhood as asymmetric spinal growth progresses.
Core concept: The magnitude of the deformity at presentation is less important than its expected growth potential and rate of progression.
Congenital scoliosis must also be regarded as a potential multisystem congenital disorder, because associated spinal cord, renal and cardiac anomalies are common.
Etiopathogenesis
During embryogenesis, paired somites undergo segmentation and resegmentation to form the vertebral bodies and posterior elements. Disturbance of this process may produce:
Failure of Formation
Part of a vertebra fails to develop.
Failure of Segmentation
Adjacent vertebrae fail to separate normally.
Mixed Defect
Formation and segmentation defects coexist.
The deformity progresses because the normal side of the spine continues to grow while…