Congenital Scoliosis: A Comprehensive Review of Diagnosis, Management, and Surgical Decision-Making in Pediatric Spinal Deformity—An Expanded Narrative Review

Congenital scoliosis is a complex spinal deformity caused by abnormal vertebral development during embryogenesis, occurring in roughly 0.5-1.0 per 1000 live births. It encompasses a wide spectrum of anomalies that arise from failures in vertebral formation or segmentation, or mixed defects during the fourth to sixth weeks of gestation. Managing this condition requires careful consideration of growth dynamics, associated systemic anomalies, and individualized decisions regarding surgical timing. In this review, current evidence on the epidemiology, pathophysiology, diagnostic strategies, and treatment of congenital scoliosis is synthesized, with special attention to surgical decision-making between hemivertebrectomy and growth-preserving methods such as growing rods. Recent surgical techniques-including magnetically controlled growing rods and posterior vertebral column resection-have expanded therapeutic options, while greater recognition of the psychosocial impacts has underscored the importance of family-centered care. Successful management relies on striking a balance between early deformity correction and preserving long-term spinal and thoracic growth. Multidisciplinary collaboration and thorough family counseling remain central to optimizing both structural and psychosocial outcomes.