Children with all three major causes of scoliosis should have a careful evaluation of the lower extremities as part of their spinal examination to determine associated or contributing components to the spinal deviation. A structural scoliosis is defined as a spinal curvature that does not correct during recumbent, lateral flexion radiographs. The two most common causes of a structural scoliosis are congenital and idiopathic. A nonstructural scoliosis can be reduced when lying down, and will correct with recumbent lateral flexion. Of the three major etiologies of scoliosis, this is the least common.
Congenital scoliosis develops secondary to a bony anomaly of the sacrum, vertebrae or ribs.
These are often defects of formation or segmentation, resulting in wedged, blocked, or hemi-vertebrae. In some cases, the abnormality will require corrective surgery. In many children, a heel lift or shoe buildup can provide sufficient structural support, and help to maintain a balanced spine. When a congenital spinal anomaly is discovered, it's important to remember that there are usually multiple affected areas. For instance, it is more common to have multiple bony abnormalities than just a single level.