Rotation of the spine in congenital scoliosis

We reviewed the progression of spinal rotation in 100 consecutive patients with 119 curves. Eighty-four patients had a single curve and composed this study. Thirty-nine cases were due to failure of segmentation, 38 cases were due to failure of formation, and seven cases were unclassifiable. Sixty-five of the patients eventually underwent spinal arthrodesis, and 19 of the patients were treated with nonoperative means, such as bracing or observation. Cases of unilateral bar, hemivertebra, and wedge vertebra showed progressive rotation, regardless of the type of treatment; however, progression of curve magnitude was limited by spinal arthrodesis. Rotation of the spine was not seen in patients with block vertebrae. Rotation of the spine and progression of curve magnitude varied in cases of complex vertebral deformities. Because of the uncertainty of remaining growth potential in congenitally dysplastic vertebrae, future growth in the spine should be considered before the undertaking of operative procedures.