Congenital Scoliosis (Scoliosis Present from Birth)

Congenital scoliosis happens when one or more of the spine's building blocks (vertebrae) didn't form properly before birth. Most children with it do fine with regular check-ups and X-rays, and only some go on to need surgery. Because it starts so early in development, it's sometimes linked to how the kidneys or heart formed too, so we screen for both as part of a proper work-up.

Reviewed by Dr. Kshitij Chaudhary — Last reviewed September 2026

What is congenital scoliosis, and what causes it?

Every baby's spine starts out as a simple column of cells that has to split, fold and shape itself into 33 separate vertebrae. Congenital scoliosis happens when that process goes slightly wrong, usually in the first six weeks after conception, long before most parents even know they're pregnant. A vertebra might not form fully, or two vertebrae might not separate the way they should.

This isn't something you did or didn't do during pregnancy. It also doesn't appear to run in families. Researchers have looked for a genetic link and haven't found a strong one, so if you're planning another child, this diagnosis alone isn't a reason to expect it again.

The curve itself is caused by uneven growth. If one side of a vertebra grows normally while the other side is stuck or fused, the spine tilts toward the slower-growing side as the child gets taller. That's why the curve isn't usually a problem at birth. It's a problem that builds up over years of growth.

Who gets it, and when is it usually found?

It's a rare condition, and it shows up differently in different children. Some are picked up on a prenatal ultrasound, others are noticed by a paediatrician in the first year or two of life, and a fair number aren't found until adolescence, when a growth spurt makes a mild curve suddenly visible.

Because the spinal cord develops around the same time as the vertebrae, and the kidneys and heart develop on a similar timeline, congenital scoliosis can sometimes come with other anomalies in those systems. That's not meant to alarm you. It's simply why we check more than just the spine when we evaluate a child with this condition.

How serious is it?

That depends entirely on the type of vertebral anomaly, and this is genuinely one of those conditions where "it depends" is the honest answer rather than a dodge.

Some anomalies have almost no growth potential and barely progress at all. Others carry real potential for the curve to worsen steadily through childhood. We classify the anomaly by how much growth is still happening in it:

A hemivertebra sitting opposite a set of fused vertebrae on the other side tends to be the combination most likely to progress, since one side keeps growing while the other stays locked in place.

What are the symptoms?

In a baby or toddler, there often aren't any obvious ones. Parents sometimes notice one shoulder or hip sitting higher than the other, a slight lean to one side, or an asymmetry in the back when the child bends forward. In older children, the same signs appear alongside a visible curve or rib prominence on X-ray.

Because congenital scoliosis can affect the spinal cord's development too, we also check for things like uneven reflexes, changes in leg strength or coordination, or skin markings over the spine (a dimple, a tuft of hair, a birthmark). These can be a clue that something under the surface needs a closer look.

How is it diagnosed?

An X-ray is where this almost always starts. On an X-ray, a malformed vertebra tends to look wedge- or triangle-shaped instead of the usual rectangle, and that's often enough to raise the flag.

From there, we build a fuller picture:

• MRI looks at the spinal cord itself, since the same developmental hiccup that affects the bones can sometimes affect the cord too. It uses no radiation, though very young children may need light sedation to stay still for it.
• Abdominal ultrasound checks the kidneys. Around one in four children with congenital scoliosis has some kind of kidney anomaly, so this is a standard part of the work-up, not an extra precaution.
• An echocardiogram checks the heart, since roughly one in ten children with this condition has an associated heart anomaly.
• CT scan gives the clearest 3D picture of the bone itself and is usually reserved for surgical planning, since it carries a higher radiation dose than the other tests.
• We'll also examine your child's hands and feet, since congenital spine anomalies can sometimes appear alongside things like clubfoot.

None of this needs to happen in one sitting. MRI, ultrasound and echo are often spread out as your child gets a bit older and can tolerate them more easily.

Will it get worse?

At the time of diagnosis, nobody, however experienced, can tell you exactly how a congenital curve will behave over the next ten years. What we can do is watch it closely and act early if it starts to move.

A few things make progression more likely: anomalies in the upper back (thoracic spine), several fully segmented hemivertebrae on the same side, or a hemivertebra opposite a bar of fused vertebrae. Two windows matter most for monitoring, since they're when the spine grows fastest: the first five years of life, and again around the growth spurt of adolescence.

Non-surgical treatment

For curves that are mild or slow-moving, treatment often means watching rather than acting. That means regular visits with an X-ray at intervals your surgeon sets based on your child's specific anomaly and age, adjusted more frequently during the fast-growth years.

Bracing or, in younger children, casting can sometimes hold a curve steady while the child keeps growing, buying time and in some cases avoiding surgery altogether. It works best on certain curve patterns and is far less effective on others, so whether it's worth trying comes down to the specific anomaly your child has.

When is surgery needed?

Surgery comes into the picture when observation shows the curve is progressing despite bracing, or when the anomaly is one we already expect won't respond to bracing at all, based on how much growth potential it has.

This is a decision best made with a clear view of the anomaly and the cord underneath it. If you've already been told your child may need surgery and want a second set of eyes on the MRI and X-rays before deciding, that's something we're happy to help with.

What does surgery involve?

The approach depends heavily on the type and location of the anomaly, your child's age, and how much growth is left. Options range from removing the abnormal vertebra (hemivertebra excision) to fusing a short segment of the spine, to growth-friendly techniques designed to control the curve while still allowing the chest and spine to keep growing in younger children. We'll walk you through exactly which approach fits your child's anomaly and why, once we've reviewed the full imaging.

What does recovery look like?

Recovery varies with the type of surgery and your child's age, and we'll go through what to expect in detail before the operation, not just after. In general, children tend to bounce back from spine surgery faster than adults do, but the plan for activity, bracing after surgery, and follow-up X-rays is tailored to each case.

Can it be prevented?

No. Since the anomaly forms in the first six weeks after conception, before most pregnancies are even confirmed, there's nothing that could have been done differently, and nothing you need to do differently next time. What matters from here is early diagnosis and the right monitoring schedule, not anything from before birth.

Questions to ask your doctor

• What type of vertebral anomaly does my child have, and how much growth potential does it have?
• How often will we need X-rays, and at what point would you recommend bracing or surgery?
• Has my child been checked for kidney and heart anomalies?
• If surgery becomes necessary, what would it involve at my child's age?

Treatments we offer for this

Hemivertebra excision, spinal fusion, growth-friendly instrumentation (growing rods), bracing and casting programmes.

This information is for general education and does not replace a consultation with your doctor.