Osteopathic (congenital) scoliosis

Congenital scoliosis is due to insult to embryo during 4th to 6th weeks
Classified
- defects in segmentation
- defects in formation
- mixed
Most common forms of osteopathic scoliosis are:
- Hemivertebrae
- Wedged vertebrae
- Fused vertebrae
- Absent or fused ribs
Others:
- Rickets
- Osteomalacia
- Fractures
Patients with congenital anomalies often have overlying skin abnormalities such as angiomas, naevi, excess hair, dimples, or fat pads
Spina bifida may be associated
There is high rate of urological abnormalities (20%). Klippel Feil syndrome is found in 25% & congenital heart disease in 25%
Bracing is not usually of benefit because curve is rigid, & when applied to young children with congenital scoliosis may restrict development of chest & lungs
Progression may be severe, particularly in cases of unilateral fusion of vertebra (unilateral unsegmented bar) & in these cases early prophylactic posterior fusion is required, at age 1-2
Young patients with segmented hemivertebra between T12-L3 can have hemivertebra excised with good results, providing good curve correction
Patients with hemivertebra & curve of limited length (less than or equal to 5 vertebrae), reasonable magnitude (less than 70°), concave growth potential & age less than 5 years can be treated with convex hemiarthrodesis & hemiepiphysiodesis
NB. BEFORE OPERATION MRI OR MYELOGRAPHY IS ESSENTIAL TO RULE OUT DIASTEMATOMYELIA