Congenital scoliosis is caused by a malformation of one or more vertebrae, or a manufacturing defect. Congenital scoliosis may only become noticeable when the child goes through a growth spurt around age 2 and between 8-13 years of age. More involved spines are usually appreciated at younger ages. Congenital scoliosis may be associated with kidney and heart conditions, as well as some neurological involvement.
What are the symptoms?
Congenital scoliosis may be detected by your pediatrician recognizing a slightly abnormal spine, with no pain. Signs of a problem include clothing that doesn’t fit correctly, tilted shoulders, protrusion of one shoulder blade, prominent ribs on one side, an uneven waistline, one hip higher than the other, and the appearance that the child is leaning to one side. In rare cases the spinal cord or nerves may be involved causing weakness, numbness and a loss of coordination.
How is congenital scoliosis diagnosed?
Any parent who suspects scoliosis should see their pediatrician who may refer to a scoliosis specialist for further testing and imaging studies.
Early diagnosis is important because the curve can progressively worsen and could affect the child’s quality of life. It is also important to rule in or out kidney and cardiac abnormalities which are frequently associated with congenital scoliosis.
Dr. Shufflebarger will take a detailed medical history, ask about your child’s growth patterns, conduct a physical exam and may also include testing for muscle weakness, numbness and abnormal reflexes. An MRI may be indicated to determine if a cyst or tethering is present.
EOS is a 3-D imaging test that uses micro doses of radiation and produces high-quality images of your child when they are standing. EOS is advantageous for use in creating an individualized treatment plan for your child. EOS imaging is about 20 times less radiation than a CT scan, which is beneficial for children who need frequent imaging studies.
What are the treatment options?
Treatment planning is determined by your child’s age, the type of abnormality, the curve’s severity and the existence of other medical conditions. Dr. Shufflebarger will determine the risk of the curve worsening and recommend treatment based upon all these considerations.
Nonsurgical treatment may include monitoring every 6-12 months with x-rays to assure the curve is not worsening. Worsening commonly occurs around the time of childhood and adolescent growth spurts. Braces will not prevent or treat the curvature but may be recommended to prevent or control compensating curves of normal vertebrae. Surgery is the only option to treat a progressively worsening curvature.
The goal of surgery is to permit the spine and chest to grow as much as possible. Commonly early surgery before 3 years of age is recommended for children whose curves are worsening, have significant deformities of the spine and trunk, and who develop neurological problems due to an abnormal spinal cord. Spinal fusion surgery while a child is young provides excellent results and can allow the child to reach normal or almost normal function. After healing, the child may participate in activities they choose and can perform.
- Spinal fusion to equalize bone growth on both sides of the spine.
- Removal of a part of the malformed bone.
- Growing rods are attached to the spine above and below the curve to allow for growth. The child is evaluated every 6-8 months and the rods can be lengthened with a minor surgical procedure. Once the child is fully grown, the rods are removed, and the spine is fused.
- Post – surgery the child may go home within a week.
- Post – surgical rehabilitation is important.
- The child may need to wear a cast or brace for 3-4 months.
Parents are fortunate to have access to a nationally and internationally recognized expert in the care and treatment of congenital scoliosis. Dr. Harry Shufflebarger was the chief of spinal surgery at the Nicklaus Children’s Hospital in Miami, Florida. In addition to his many accomplishments in research and innovation in pediatric spine conditions, he is a kind and compassionate doctor who is sought out by parents the world over.