Article By Dr. Rohan Gala, Visiting Spine Consultant, UMC Victoria Hospital
Scoliosis — an abnormal sideways curve of the spine — is often thought of as a teenage problem. But for some children the curve is present at birth: congenital scoliosis, caused by malformations of the vertebrae during fetal development. In East Africa, where data are limited and specialist services are scarce, congenital and other pediatric spinal disorders create a quietly heavy burden on families and health systems. This article summarizes the best-available regional evidence, explains treatment options, highlights recommended ages for screening, and gives a practical framework of questions patients and parents should ask their doctor.
How common is it?
Global estimates for scoliosis vary widely depending on the type and how it is measured. A 2024 review found that congenital scoliosis is uncommon but measurable — around 0.2% of children overall in pooled studies (estimate 0.12%–1.2%). This is substantially lower than rates reported for adolescent idiopathic scoliosis (the common teenage form). (Frontiers)
Scoliosis screening studies in sub-Saharan Africa show a wide range of results: school-based surveys report prevalences for spinal curvature of roughly 3–5% for some screened school populations, while other focused studies show different figures depending on methods and age groups. The scarcity and variability of data make precise burden estimates for East Africa difficult. (ScienceDirect)
Uganda-specific data on congenital anomalies and birth defects (including spinal and neural tube defects) come from hospital-based surveillance and epidemiological studies over the past decade. These studies confirm that congenital malformations, while not the leading cause of hospital admission overall, are recognizable contributors to paediatric surgical need in hospitals around Kampala and other districts. Still, national-level, population-wide figures for congenital scoliosis specifically are not yet robust. (PMC)
Why early detection matters
Spinal curves can progress with growth. When a spinal curve is detected early — especially before or during the adolescent growth spurt — non-surgical options such as observation and bracing can control progression in many cases. For congenital curves that are structural from birth, early specialist assessment matters because growth-modulating surgical techniques (e.g., growing rods) or carefully timed fusion surgery can prevent severe deformity and cardiorespiratory compromise. International surgical societies therefore recommend targeted screening for children at key ages so that progressive curves are not missed. (srs.org)
Who treats these children in Uganda and East Africa?
Specialised paediatric spinal services are limited but growing. NGOs, surgical missions and specialist hospitals (including regional centres and dedicated paediatric surgical hospitals) provide a large share of complex spine care and training. Organisations such as CURE Uganda and several spine surgery missions have been active in delivering neurosurgical and orthopaedic spine procedures, training local teams and increasing local capacity. Nonetheless, many families still travel long distances or wait for visiting missions for complex operations. (CURE –)
Treatment options
- Observation (watchful waiting)
Appropriate for mild curves (small Cobb angle) with no progression. Regular follow-up with clinical exam and periodic X-rays during growth. - Bracing
Used mainly for adolescent idiopathic scoliosis when the child is still growing and the curve is moderate; bracing can reduce progression risk. Not usually effective for rigid congenital vertebral malformations. - Physical therapy and targeted exercises
Helpful for pain relief, posture and function; may be part of conservative management but not usually curative for structural congenital deformities. - Growth-friendly surgical options (for young children)
Techniques such as growing rods, magnetically controlled rods, or guided growth systems aim to control deformity while allowing spinal growth. Timing and follow-up are critical. - Spinal fusion and corrective surgery
Standard for many severe curves once the child has sufficient growth or when deformity threatens function. These are major operations requiring multidisciplinary perioperative care. - Care for associated conditions
Children with congenital scoliosis may have associated organ anomalies (kidney, heart, neural tube defects). A comprehensive workup is important before major surgery. (Frontiers)
Recommended ages for screening and checkups
Several international bodies recommend targeted screening during the years children grow fastest:
- Girls: screen around 10 and 12 years (or grades 5 and 7).
- Boys: at least once around 12–13 years.
- Younger children with visible trunk asymmetry, uneven shoulders/hips, or concerns from parents should be evaluated earlier. These age windows aim to catch adolescent idiopathic curves during the early growth spurt; congenital scoliosis may be suspected at birth or in early childhood if visible deformity or asymmetry exists. (srs.org)
Practical framework — how to approach a suspected case
- Start with a good history: birth history, prenatal exposures, family history of spine problems, developmental milestones, pain or breathing difficulty.
- Clinical examination: Adam’s forward bend test, measurement of shoulder/hip height, neurological exam.
- Imaging: plain X-rays (standing full-spine AP and lateral) are the first step; MRI is essential if congenital anomalies, neurological signs, or intraspinal lesions are suspected.
- Multidisciplinary evaluation: orthopaedic surgeon or neurosurgeon with paediatric experience, physiotherapist, anaesthetist, and — if needed — cardiology or nephrology for associated anomalies.
- Discuss timing and goals of treatment: for congenital cases, the priority is preventing progression while preserving growth and function.
Questions to ask your doctor — and short answers you should expect
Does my child have congenital scoliosis or another type?
The doctor should explain whether the curvature is congenital (vertebral malformation present from birth), idiopathic (appears in adolescence), neuromuscular, or syndromic — based on exam and imaging.
How severe is the curve (Cobb angle) and is it likely to get worse?
Expect a numeric Cobb angle on X-ray. The physician should state the risk of progression and why (age, location of curve, growth remaining).
What imaging do we need now?
Standing full-spine X-rays usually first; MRI if there are neurological signs or suspected intraspinal anomalies; kidney/heart checks if congenital defects are suspected.
What are non-surgical options and will they help my child?
A: For mild or flexible curves: monitoring, physiotherapy and in adolescents, bracing. The doctor should explain realistic goals and success rates.
If surgery is recommended, what type and what are the risks?
The surgeon should explain the specific procedure (growth rods, fusion, vertebral resection), expected benefits, risks (infection, nerve injury, blood loss), hospital stay, and long-term follow-up.
Are there other organ systems we should check?
Yes — congenital spinal anomalies often co-occur with kidney, cardiac, or neural tube defects; appropriate screening tests should be offered.
What local services are available and do we need to travel for specialist care?
The team should outline local surgical capacity, NGOs or referral centres (some families need to attend tertiary centres or missions for complex surgery).
How will this affect school, activity and long-term function?
Expect advice on when to restrict high-impact sports, when to return to school, and realistic expectations for mobility and respiratory function.
Closing note
Families in Uganda and across East Africa should know that congenital spine conditions are diagnosable and, in many cases, manageable — especially when detected early and managed by a multidisciplinary team. Improvements in local surgical capacity, training programmes and international partnerships have increased access to care, but gaps remain. If you suspect a spinal problem in a child, start with a primary care or paediatric visit and ask for an orthopaedic or neurosurgical evaluation — armed with the questions above.
Key sources and further reading: recent reviews on congenital scoliosis prevalence and screening guidelines; Uganda hospital studies on congenital anomalies and regional spine surgery missions (selected studies and hospital resources). (Frontiers)
Source:
Here are some of the source links for the data and statements in the article:
- “Epidemiological and Diagnostic Characteristics of Scoliosis in Sub-Saharan Africa” — full text via PMC. PMC
Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC9290356/ - “Paediatric musculoskeletal disease in Kumi District, Uganda: a cross-sectional survey” — gives broader MSK burden in children. ResearchGate
- “Prevalence of Paediatric Surgical Conditions in Eastern Uganda” (cross-sectional study) — shows surgical burden including congenital anomalies. NRU+1
Link: https://nru.uncst.go.ug/bitstreams/14d565e1-5945-4d64-98ec-cb5997013250/download - “Quantifying the pediatric surgical need in Uganda” (Butler et al.) — gives lifetime and current prevalence of surgical conditions in children in Uganda. PubMed
- “Surgical outcomes in children under 10 years old in the treatment of congenital scoliosis…” — focuses on congenital scoliosis surgical timing/outcomes. BioMed Central
