Congenital Scoliosis: Etiology, Clinical Management and Current Treatment Strategies

Congenital scoliosis is a structural spinal deformity resulting from developmental disturbances of the vertebral column during early embryogenesis. It presents with marked clinical heterogeneity, and its natural history depends on the type and anatomical location of the anomaly, as well as the child’s remaining growth potential. Although the deformity may be evident at birth, many cases are identified incidentally in early childhood. More than half of patients develop progressive curvature, often requiring timely intervention. Curve progression is strongly influenced by periods of rapid growth—particularly within the first three years of life and during puberty—making close monitoring and individualized treatment planning essential. The etiology is multifactorial. Familial clustering suggests a genetic contribution, and associations with syndromes such as CHARGE, Klippel–Feil, and VACTERL reflect a broad genetic spectrum. Mutations in genes including TBX6, FBN1, and LFNG have been implicated. Environmental factors—such as gestational diabetes, maternal hypoxia, tobacco exposure, febrile illness, alcohol use, and certain medications—may also contribute to vertebral malformations. Nutritional deficiencies, including rickets and malnutrition, can further affect spinal development. Congenital scoliosis is frequently accompanied by systemic anomalies involving the renal, cardiac, and thoracic systems. Identifying these comorbidities is critical, as they may increase perioperative risk and influence long-term outcomes. This review outlines the etiology, classification, clinical evaluation, and treatment principles of congenital scoliosis, emphasizing practical strategies for contemporary surgical decision-making.