Congenital scoliosis due to hemivertebra: a review of literature and management strategies

Background: Hemivertebra is a common congenital problem resulting in varied deformities of the spine. Etiopathogenesis of hemivertebra is still not clear. But the spectrum of cases resulting from hemivertebra pose a clinical challenge especially in growing skeleton. The progression of deformity also depends upon part of spine involved. The treatment can be conservative or surgical. Multiple factors are taken into consideration before embarking on any treatment modality. Aims and objective: To evaluate the the role of conservative management and surgical treatment for the management of congenital scoliosis resulting from hemivertebra and draw an inference based on our observations. Material and Methods: We identified 3 cases from our database. One case was a 12 year old child with upper dorsal scoliosis who was managed conservatively. 2nd case was a 23 year patient with l2 hemivartebra who was also managed conservatively. And 3rd case was a 11 yr patient had progressive dorsolumbar kyphoscoliosis who was managed by surgery. Results: In in first 2 cases, bracing and serial follow ups showed progression of not more than 2 degrees per year and resulted in stable spine with no deficits. In the 3rd case, timely surgical intervention with a stable construct resulted in halting of progression of deformity. Conclusion: Regular follow up with imaging plays a vital role in management of these cases. Assessment of progression and choosing appropriate line of management will benefit these cases effectively. A systematic review of literature and understanding the biomechanics and progression of deformity is very essential in deciding the treatment options.