[The pathomorphology of congenital spinal defects in relation to future clinical development of the disease]

The authors categorised congenital malformations of the spine into five different pathomorphologic groups basing on a series of 61 cases (age ranging from 1 to 50 years): defects of the vertebra, of the vertebral body, intervertebral synostosis, rib synostosis, and defects of the vertebral arch. A total of over 30 different kinds of malformations were obtained in this classification. In the analysed series 34 patients had a predominant kind of malformation, while in 27 cases mixed malformations were noted. These malformations lead to spine deformities: 21 cases with arch scoliosis, 15 cases with kyphoscoliosis, 13 cases with angular scoliosis and 12 cases with kyphosis. Deformities had a tendency to progress with age. In 20 patients neurological deficits (increased spasticity, spastic paresis, spastic and flaccid paralysis) increased after reaching skeletal maturity. Prognosis as to deformity regression was made difficult be the large variety of different pathomorphologic types of deformity. Only general patterns were visible e.g. a tendency to progress in cases were hemivertebra were found. In cases were more than one type of deformity was noted, growth balance of the spine was not a rule. On the contrary, even small mixed deformities of ten progressed. This paper indicates that most congenital deformities of the spine should be treated operatively, either to correct the deformity or to attain spine growth balance.