Unlike idiopathic scoliosis, you cannot use casts or braces to “cure” congenital scoliosis.  In a small percentage of children, mostly those with very flexible lumbar curves, a brace can be used to help slow down progression of a curve and buy time before surgery is needed. More recent studies have shown that casting can be helpful in a certain population of young children with flexible curves that are progressing quickly.   However, you cannot “fix” bones that never formed correctly. Again, these options are methods to slow down progression and gain time for growth prior to surgery to actually treat the curve.

Standard treatment for congenital scoliosis is “watch and wait”… usually a baby will be seen by the orthopedic doctor for x-rays every 3-6 months, depending on the anomaly and how likely it is to progress.  The first five years of age, and then again during the adolescent growth spurt, are when you are most likely to see curves progess as your child grows.  Some types of malformations will do little, if anything and won't require surgery.  Some will slowly grow, eventually requiring surgery.  Others can progress rapidly, leading to early surgery. 

The three main types of surgery used to treat congenital scoliosis are fusion, hemivertebra excision and implantation of a device that helps correct the curve while allowing the spine to still grow, something especially important when dealing with the thoracic area. 

In the past, many doctors believed that fusing the area that was curving as soon as it became a problem was the best method for dealing with scoliosis.  Nowadays, most doctors who deal regularly with congenital scoliosis prefer to hold off on fusing the spine for as long as possible, to allow for as much growth in height and chest capacity as can be safely had.  The development of devices such as growing rods, including VEPTR, Shilla and MAGEC rods, now allows doctors the option of still dealing with a rapidly developing curve without having to fuse the spine in an infant or toddler. 

Isolated hemivertebrae that cause curve progression can often, depending on the location, be removed and a small fusion of the surrounding vertebrae done.  This is often done earlier in age, due to the limited amount of fusing that needs to be performed.