الگوها و نحوه پيشرفت در اسكوليزر مادرزادي

Patterns and Progression in Congenital Scoliosis

Background: Congenital scoliosis has often a progressive course, resulting into major cosmetic and functional problems. Early detection of malicious patterns and early treatment planning could prevent major deformities. The distribution of its different forms and treatment results has not been previously reported in Iran. This study presents the incidence and treatment outcome in Southern part of Iran. Materials and Methods: Sixty cases of congenital scoliosis over a I3-year period were studied. The pattern of deformities, all demographic data, the associated anomalies including renal, cardiac, and, in particular, neural canal defects, were studied. The progression of deformities and the results of treatment were evaluated clinically and radiographically. Results: Two peaks of presentation were seen - one in 2 years and another in 8-13 years of age. Parental consanguinity was seen in 40% of cases. From the five patterns that were observed, Hemi vertebra was the most common; and unilateral unsegmentcd bar with contralateral Hemi vertebra the most progressive form. Curves at thoracic level were most prevalent. Curve progression index was 9 degrees when un-segmented bar was presenting with a contralateral Hemi vertebra, and 6 degrees without such a combination. This index was 1.5 degrees for Hemi vertebra and 0.5 for block vertebra. Presence of fused ribs on concave side of lower thoracic curves was associated with increased progression rate. Spinal dysraphism was diagnosed in 20% of cases. Conclusion: Early detection of progressive patterns of congenital scoliosis and early intervention is necessary. Fusions on concave side of curve are associated with faster progression and may contribute to pulmonary insufficiency.