Prognostic significance of the Nasca classification for the long-term course of congenital scoliosis.
OBJECTIVE
The aim of our investigations was to answer the question of whether the radiologic classification according to the investigations of Nasca has prognostic relevance for congenital scoliosis. Based on our results, a therapeutic concept was given.


METHODS
Radiographs of 49 patients with a congenital scoliosis were classified according to Nasca. The progression of the malformation was analyzed by regarding the changes over a period of 8.3 years on average.


RESULTS
Of the analyzed patients with congenital scoliosis, 73% showed a mean progression rate of 1.8 degrees per year. The most advanced progress of the Cobb angle per year was seen in patients with unilateral unsegmented bars with or without additional hemivertebrae (type 4 according to the Nasca classification) and patients with wedge-formed vertebrae (type 2a according to the Nasca classification). The presence of unilateral bars and the location of the hemivertebra or hemivertebrae (type 4) and wedge-formed vertebrae (type 2a) are the major determinants of deformity. Within the scope of our investigations, the following three factors were seen as deleterious when combined: thoracolumbal and long-distance scoliosis, female gender, and prepubertal growth period.


CONCLUSIONS
From our analysis of 49 patients, we can propose the following therapeutic system for congenital scoliosis. Sole treatment with physiotherapy should only be recommended with congenital scoliosis curves ranging from 0 degrees to 20 degrees according to the Cobb method. With a Cobb angle smaller than 40 degrees and some flexibility remaining in the spine, the congenital scoliosis should be treated additionally with corrective casts. For congenital scoliosis with a Cobb angle of more than 50 degrees, as well as for congenital scoliosis with a poor prognosis (for example unilateral bars), a spondylodesis of the spine should be done before reaching the age of 5 years.
Birnbaum
K
K
Orthopaedic Department, Technical University Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. kbirnbaum@orthopaedie-aachen.de
Weber
M
M
Lorani
A
A
Leiser-Neef
U
U
Niethard
F U
FU
D002370:Casts, Surgical; D002648:Child; D018450:Disease Progression; D006801:Humans; D026741:Physical Therapy Modalities; D011379:Prognosis; D011859:Radiography; D012600:Scoliosis / Q000145:classification* / Q000151:congenital / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D013123:Spinal Fusion