Congenital Scoliosis Surgery in New York City
Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director, Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY
Congenital scoliosis is fundamentally different from adolescent idiopathic scoliosis. It is not caused by unknown factors during puberty — it is caused by a structural abnormality of one or more vertebrae that forms during fetal development, typically in the first six weeks of pregnancy. These bony abnormalities create asymmetric growth of the spine from birth onward, producing curves that can progress rapidly and unpredictably. Without appropriate treatment, severe congenital scoliosis can lead to significant spinal deformity, compromise of lung and chest wall development, and in some cases neurological injury.
Dr. Sardar specializes in the surgical management of congenital spinal deformity in patients from age 10 through adulthood. He works closely with multidisciplinary teams at the Och Spine Hospital at NewYork-Presbyterian / Columbia University to ensure that patients with congenital scoliosis receive the most appropriate, individualized care at every stage of their treatment.
WHAT IS CONGENITAL SCOLIOSIS?
Congenital scoliosis results from vertebral malformations that arise during embryological development. These malformations fall into three main categories:
- Failure of formation — part of a vertebra fails to form, resulting in a hemivertebra (a wedge-shaped half-vertebra on one side of the spine). Hemivertebrae are the most common cause of congenital scoliosis and create the most asymmetric growth, making them the most likely to cause progressive deformity.
- Failure of segmentation — two or more adjacent vertebrae fail to separate normally, creating a bony bar that fuses them together on one side. This unilateral bar prevents growth on the affected side while growth continues normally on the opposite side, producing progressive lateral curvature.
- Mixed defects — a combination of both failure of formation and failure of segmentation, which carries the highest risk of rapid progression.
The risk of progression depends on the type and location of the malformation, the patient’s remaining growth potential, and whether there are associated spinal cord or rib abnormalities. Some curves progress rapidly in early childhood; others remain stable for years and then accelerate during the adolescent growth spurt.
ASSOCIATED CONDITIONS
Congenital scoliosis is frequently associated with abnormalities in other organ systems, because the developmental processes that form the vertebrae occur simultaneously with the development of other structures. Every patient with congenital scoliosis should be evaluated for:
- Spinal cord and intraspinal abnormalities — diastematomyelia (split spinal cord), tethered cord, syringomyelia, and other intraspinal anomalies are present in 20–40% of patients with congenital scoliosis; MRI of the entire spine is mandatory before surgical planning
- Cardiac defects — congenital heart disease occurs in approximately 12% of patients with congenital scoliosis; cardiac evaluation is essential before any major surgery
- Genitourinary anomalies — renal and urologic malformations are found in 20–30% of patients; renal ultrasound is standard in the workup
- Rib and chest wall abnormalities — fused ribs or rib anomalies on the concave side of the curve can impair chest wall growth and lung development
- Cervical spine anomalies — Klippel-Feil syndrome and other cervical fusions may coexist with thoracic or lumbar congenital scoliosis
DIAGNOSIS AND EVALUATION
A thorough evaluation is essential before any treatment decision is made. This includes:
- Full-length standing X-rays — to measure the Cobb angle, identify the type of vertebral malformation, and assess overall spinal balance
- CT scan — provides detailed three-dimensional imaging of the bony anatomy, essential for characterizing the malformation and planning surgery; 3D reconstructions are particularly valuable for hemivertebra resection planning
- Full-spine MRI — mandatory to identify intraspinal abnormalities before any surgical intervention; these must be addressed before or during deformity correction surgery
- Cardiac evaluation — echocardiogram and pediatric cardiology consultation as indicated
- Renal ultrasound — to identify genitourinary anomalies
- Pulmonary function testing — in older patients with significant thoracic deformity, to assess respiratory reserve before surgery
WHEN IS SURGERY INDICATED?
Unlike adolescent idiopathic scoliosis, bracing is generally not effective for congenital scoliosis because the deformity is driven by a structural bony abnormality rather than asymmetric soft tissue forces. Observation alone may be appropriate for stable, non-progressive curves — but many congenital curves require surgical intervention, and earlier surgery is often preferable to allow deformity correction before the curve becomes severe and rigid.
Surgery is generally recommended when:
- The curve is progressive — documented increase on serial X-rays
- The curve has reached a magnitude where spontaneous deterioration is predictable based on malformation type and growth remaining
- Thoracic insufficiency syndrome threatens lung development
- There is neurological deficit from intraspinal pathology or direct cord compression
- The deformity has progressed to a magnitude that significantly impairs function or quality of life
SURGICAL OPTIONS
Hemivertebra Resection
For isolated hemivertebrae causing focal deformity, hemivertebra resection — complete surgical removal of the abnormal vertebra — followed by short-segment fusion is the definitive treatment. This procedure removes the source of the asymmetric growth and allows correction of the curve at its origin. When performed early, it can prevent the development of long compensatory curves above and below. It is technically demanding surgery that requires experience with spinal deformity and intraoperative neuromonitoring throughout.
Posterior Spinal Fusion
For congenital curves that are not amenable to hemivertebra resection — due to location, the number of levels involved, or the presence of unilateral bars — posterior spinal fusion with instrumentation is the primary surgical approach. The goal is to halt progression and achieve the maximum safe correction. In young children with significant remaining growth, the levels to be fused must be carefully chosen to minimize the impact on thoracic growth and lung development.
Growth-Preserving Techniques
In young children with significant growth remaining and curves too large or complex for early definitive fusion, growth-preserving constructs — including growing rods and VEPTR (vertical expandable prosthetic titanium rib) — allow control of curve progression while preserving thoracic growth. These devices require periodic lengthening procedures (traditionally every 6 months, though magnetically controlled growing rods allow non-surgical lengthening) until the child reaches an appropriate age for definitive fusion.
Combined Anterior-Posterior Surgery
In some complex cases, particularly those with rigid curves or the need for anterior release and interbody support, a combined anterior and posterior approach may be used. This is less commonly required in the era of modern posterior instrumentation but remains an option for selected cases.
Intraoperative neuromonitoring isused as standard in all congenital scoliosis surgical procedures, providing real-time feedback on spinal cord and nerve root function throughout the case.
FREQUENTLY ASKED QUESTIONS
Is congenital scoliosis the same as idiopathic scoliosis?
No. Adolescent idiopathic scoliosis has no identified structural cause and develops during the growth spurt of puberty. Congenital scoliosis is caused by vertebral malformations that arise during fetal development and are present from birth. The two conditions have different natural histories, different risks of progression, and different treatment strategies. Bracing, which is a primary non-surgical treatment for adolescent idiopathic scoliosis, is generally not effective for congenital scoliosis.
How quickly does congenital scoliosis progress?
Progression depends on the type of malformation. A unilateral unsegmented bar with a contralateral hemivertebra — the combination of failure of segmentation and failure of formation on opposite sides of the same level — has the highest risk of rapid progression: up to 10 degrees per year. Isolated hemivertebrae progress at intermediate rates. Some curves remain stable for years and then accelerate during the adolescent growth spurt. This unpredictability is one reason close monitoring with serial X-rays is essential in children with congenital scoliosis.
Does congenital scoliosis affect breathing?
It can, particularly when the congenital abnormality involves the thoracic spine and is associated with rib fusions or chest wall abnormalities. Thoracic insufficiency syndrome — a condition in which the thoracic cage cannot support normal lung growth and breathing — is a serious complication of severe early-onset thoracic deformity. Surgical treatment is aimed in part at preserving thoracic growth and lung development in affected children.
WHY CHOOSE DR. SARDAR
Congenital scoliosis surgery requires a surgeon with deep experience in complex spinal deformity, thorough familiarity with the associated anomalies that must be identified and addressed, and the technical skill to perform procedures — particularly hemivertebra resection — that are rarely encountered outside high-volume deformity centers.
As Co-Chief of Spinal Deformity Surgery at the Och Spine Hospital at NewYork-Presbyterian, Dr. Sardar treats patients across the full spectrum of spinal deformity, including complex congenital cases. He works within a multidisciplinary framework that includes pediatric cardiology, nephrology, and pulmonology to ensure that all associated conditions are identified and appropriately managed. He is an active member of the Scoliosis Research Society (SRS).
Patients travel from across the United States and internationally to see Dr. Sardar for congenital scoliosis. Telemedicine consultations are available for patients in NY, NJ, CT, FL, PA, MO, CA, and TX. International patients can contact NewYork-Presbyterian Global Services at +1-212-746-9100.
This page is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition and treatment options.
REQUEST A CONSULTATION
To schedule a consultation with Dr. Sardar, call 212-932-5187 or use the contact form below.