title: [Congenital malformations of the growing spine : When should treatment be conservative and when should it be surgical?].
abstract: Congenital malformations of the spine are caused by genetic and teratogenic factors. By means of asymmetrical longitudinal growth of the spine they can lead to deformity, most commonly to scoliosis. The malformations can be classified as failure of formation, failure of segmentation and mixed-type malformations. The extent of the deformity and its progression are determined by the remaining growth potential and the location and type of malformation. Up to one third of such deformities are associated with some sort of cardiac or urogenital malformation. The treatment concept is typically determined on an individual basis. Mild deformities often remain undetected. Conservative treatment using a brace has no substantial effect on the primary curve but might be helpful in the treatment of long sweeping, flexible, secondary curves. If rapid progression is documented or expected, surgical intervention as early as possible is warranted to prevent secondary structural changes. The surgical treatment should be focused on and limited to the site of malformation. The aim of surgery is the correction of the deformity at the site of asymmetrical growth. This can be achieved either by resection of a hemivertebra or by performing a vertebral column resection or other type of osteotomy. If notable compensatory, secondary curves are present, these can be corrected with growing rod constructs. The aim of all types of treatment is the correction of existing deformity or the prevention of its progression, in order to ensure balanced growth of the healthy regions of the spine. The present paper discusses the conservative and surgical treatment modalities available to achieve these aims.
authors.affiliation: Wirbelsäulenchirurgie, Muskulo-Skelettal Zentrum, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz.
authors.forename: T F
authors.initials: TF
authors.lastname: Fekete
authors.affiliation: Wirbelsäulenchirurgie, Muskulo-Skelettal Zentrum, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz.
authors.forename: D
authors.initials: D
authors.lastname: Haschtmann
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich Wirbelsäulenchirurgie, Universität Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
authors.forename: C-E
authors.initials: CE
authors.lastname: Heyde
authors.affiliation: Wirbelsäulenchirurgie, Muskulo-Skelettal Zentrum, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz.
authors.forename: F
authors.initials: F
authors.lastname: Kleinstück
authors.affiliation: Wirbelsäulenchirurgie, Muskulo-Skelettal Zentrum, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz. dezsoe.jeszenszky@kws.ch.
authors.forename: D
authors.initials: D
authors.lastname: Jeszenszky
mesh_terms: D000293:Adolescent; D001915:Braces; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy / Q000379:methods; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007103:Immobilization / Q000295:instrumentation / Q000379:methods*; D007223:Infant; D007231:Infant, Newborn; D007796:Laminectomy / Q000379:methods*; D008297:Male; D018579:Patient Selection; D019651:Plastic Surgery Procedures / Q000379:methods*; D012600:Scoliosis / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
keywords: Congenital scoliosis; Osteotomy; Prevention; Treatment; Vertebra