Congenital scoliosis: diagnosis and treatment

Abstract

Congenital scoliosis remains a challenge for the PMR clinician. It results from an anomaly in the vertebral development leading to its presentation in younger ages, when compared to idiopathic scoliosis. Congenital curves tend to be rigid and resistant to conservative treatment, that considering the remaining growth potential, may result in severe spine deformities.

The authors reviewed the published literature concerning congenital scoliosis, aiming at the update of the fundamental aspects in diagnosis and treatment.
Vertebral anomalies are classified in segmentation, formation, and mixt defects. Formation defects can be complete or partial, leadind to a hemivertebra ou a wedge vertebra. Among segmentation defects are the unsegmented bars and the vertebral bloc, in the complete absence of disc.

The patient evaluation consists in a complete medical history, including prenatal, birth and neonatal antecedents, family history, development milestones and system revision. Physical examination includes spine, cutaneous, thoracic, genital and limb inspection and neurologic examination. The recognition of associated anomalies is important, namely intraspinal, genito-urinary and cardiovascular, among others.

Early diagnosis and adequate follow-up are the key elements to avoid progression and complications.
X-ray allows the diagnosis of vertebral malformations, measurement of scoliotic curve progression and the determination of growth potential. Evolution depends on the affected area, type of anomaly, age at diagnosis, balance and curve pattern.
The presence of an unsegmented unilateral bar has a bad prognosis, whereas a vertebral bloc has the best prognosis.
Even though orthotic treatment remains controverse, the possibility of delay in the progression of the scoliotic curve, allowing surgery in a later age, justify its use as a treatment option, in selected cases. The treatment of scoliotic short, rigid and progressive curves is surgical.
PMR plays an important role in the diagnosis, treatment management and interface with other specialties, considering the specificity of individual treatment and hazard complications.

Keywords: Scoliosis; Spine abnormalities; Diagnosis; Treatment.