Scoliosis and congenital heart defects: a historical and analytical review of the literature

Scoliosis is a common orthopedic condition that, when progressive, requires surgical intervention. Congenital heart defects are another common pathology, often requiring surgery, most often (unlike scoliosis) for urgent or life-saving reasons. These two pathologies can and often do coexist, inevitably posing new challenges for surgeons, both cardiologists and spine surgeons. A systematic search of publications in the Pubmed/Medline electronic database was conducted using the keywords “scoliosis” and “congenital heart defect”. A total of 109 papers were identified, all with one exception in English. These papers are included in the historical and analytical literature review. An attempt was made to answer a number of questions: how often do scoliosis and congenital heart defects occur, how often is scoliosis combined with congenital heart defects, how often is congenital heart defect combined with scoliosis, what types of scoliotic deformities accompany the development of congenital heart defects, what are the mechanisms of scoliosis formation in combination with congenital heart defects, does the dynamics of the development of the musculoskeletal system change in children with congenital heart defects, and what are the results of surgical correction of scoliotic deformities against the background of congenital heart defects and of heart defects – against the background of scoliotic disease?

Scoliosis and congenital heart disease are large and important areas of clinical medicine. The combination of these pathological conditions is common, creating a new clinical entity that has not been fully studied. Surgical correction of one or both pathologies, when they coexist, presents a complex clinical challenge.

1. Yilmaz H, Zateri C, Kusvuran Ozkan A, Kayalar G, Berk H. Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study. Spine J. 2020;20:947–955. DOI: https://doi.org/10.1016/j.spinee.2020.01.008

2. Sung S, Chae HW, Lee HS, Kim S, Kwon JW, Lee SB, Moon SH, Lee HM, Lee BH. Incidence and surgery rate of idiopathic scoliosis: a nationwide database study. Int J Environ Res Public Health. 2021;18:8152. DOI: https://doi.org/10.3390/ijerph18158152

3. Thomas JJ, Stans AA, Milbrandt TA, Kremers HM, Shaughnessy WJ, Larson AN. Trends in incidence of adolescent idiopathic scoliosis: a modern US population-based study. J Pediatr Orthop. 2021;41:327–332. DOI: https://doi.org/10.1097/BPO.0000000000001808

4. Kane WJ, Moe JH. A scoliosis-prevalence survey in Minnesota. Clin Orthop Relat Res. 1970;69:216–218.

5. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013:7:3–9. DOI: https://doi.org/10.1007/s11832-012-0457-4

6. van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Amer Coll Cardiol. 2011;58:2241–2247. DOI: https://doi.org/10.1016/j.jacc.201108.025

7. Menashe VD, Osterud HT, Griswold HE. Mortality from congenital cardiovascular disease in Oregon. Pediatrics. 1967;43:334–344. DOI: https://doi.org/10.1542/peds.40.3.334

8. Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births: incidence and natural history. Circulation. 1971:43:323–332. DOI: https://doi.org/10.1161/01.cir.43.3.323

9. Donzelot E, Strohl E, Durand M, Metianu C, Heim de Balsac R. [Deformities of the spinal column in congenital heart diseases]. Sem Hop. 1951;27:2216–2223.

10. Wright WD, Niebauer JJ. Congenital heart disease and scoliosis. J Bone Joint Surg Am. 1956;38:1131–1136.

11. Luke MJ, McDonnell EJ. Congenital heart disease and scoliosis. J Pediatr. 1968;73:725–733.

12. Beals RK, Kenney KH, Lees MH. Congenital heart disease and idiopatic scoliosis. Clin Orthop Relat Res. 1972:89:112–116.

13. Jordan CE, White RI Jr, Fischer KC, Neill C, Dorst JP. The scoliosis of congenital heart disease. Am Heart J. 1972;84:463–469. DOI: https://doi.org/10.1016/0002-8703(72)90468-1

14. Roth A, Rosenthal A, Hall JE, Mizel M. Scoliosis and congenital heart disease. Clin Orthop Relat Res. 1973:(93):95–102. DOI: https://doi.org/10.1097/00003086-197306000-00011

15. Reckles LN, Peterson HA, Weidman WH, Blanco AJ Jr. The association of scoliosis and congenital heart disease. J Bone Joint Surg Am. 1975;57:449–455.

16. Shneerson JM, Sutton GC, Zorab PA. Causes of death, right ventricular hypertrophy, and congenital heart disease in scoliosis. Clin Orthop Relat Res. 1978;(135):52–57.

17. Farley FA, Phillips WA, Herzenberg JE, Rosenthal A, Hensinger RN. Natural history of scoliosis in congenital heart disease. J Pediatr Orthop. 1991;11:42–47. DOI: https://doi.org/10.1097/01241398-199101000-00010

18. Kawakami N, Mimatsu K, Deguchi M, Kato F, Maki S. Scoliosis and congenital heart disease. Spine (Phila Pa 1976). 1995;20:1252–1256. DOI: https://doi.org/10.1097/00007632-199506000-00008

19. Webb GD, Harrison DA, Connelly MS. Challenges posed by the adult patients with congenital heart disease. Adv Intern Med. 1996;41:437–495.

20. Liu L, Xiu P, Li Q, Song Y, Chen R, Zhou C. Prevalence of cardiac dysfunction and abnormalities in patients with adolescent idiopathic scoliosis requiring surgery. Orthopedics. 2010;33:882. DOI: https://doi.org/10.3928/01477447-20101021-08

21. Ipp L, Flynn P, Blanco J, Green D, Boachie-Adjei O, Kozich J, Chan G, Denneen J, Widmann R. The findings of preoperative cardiac screening studies in adolescent idiopathic scoliosis. J Pediatr Orthop. 2011;31:764–766. DOI: https://doi.org/10.1097/BPO.0b013e31822f14d6

22. Bozcali E, Ucpunar H, Sevencan A, Balioglu MB, Albayrak A, Polat V. A retrospective study of congenital cardiac abnormality associated with scoliosis. Asian Spine J. 2016:10:226–230. DOI: https://doi.org/10.4184/asj.2016.10.2.226

23. Lang C, Wang R, Chen Z, He S, Zou Q, Wu J, Zhu X. Incidence and risk factors of cardiac abnormalities in patients with idiopathic scoliosis. World Neurosurg. 2019;125:e824–e828. DOI: https://doi.org/10.1016/j.wneu.2019.01.177

24. Yang X, Zhang L, Wang Y, Zhao Z, Xie W, Lu J, Qian G, Shi Z, Li T, Li Q, Bi N, Song Z, Zhang Z. Risk factor analysis for cardiac abnormalities in patients with idiopathic scoliosis. Sci Rep. 2025;15:16013. DOI: https://doi.org/10.1038/s41598-025-99366-1

25. Xiao J, Li T, Wang Y, Zhao Z, Xie J, Zhou J. Effects of severe scoliosis on cardiac structure and function in resting patients: a retrospective study. J Orthop Surg Res. 2025;20:681. DOI: https://doi.org/10.1186/s13018-025-06113-3

26. Bisgard JD. Thoracogenic scoliosis. Influence of thoracic diseas and thoracic operations on the spine. Arch Surg. 1934;29:417–445. DOI: https://doi.org/10.1001/archsurg.1934.01180030082006

27. Bisgard JD. Experimental thoracogenic scoliosis. J Thor Surg. 1935;4:435–442. DOI: https://doi.org/10.1016/S0096-5588(20)32378-3

28. Langenskiold A, Michelsson JE. The pathogenesis of experimental progressive scoliosis. Acta Orthop Scand Suppl. 1962;59:1–26.

29. Manning C. Experimental scoliosis. In: Proceedings of a Second Symposium on Scoliosis: Causation. Edited by P.A. Zorab, Edinburgh and London: E.&S. Livingstone Ltd, 1968:11.

30. Volkmann R. The diseases of the locomotor organs. In: Handbuch der allgemeinen und speziellen Chirurgie. Edited by von Pitha FR, Billroth T. Ferdinand Enke Verlag, Erlangen, 1869. Band II;1;694.

31. Stauffer ES, Mankin HJ. Scoliosis after thoracoplasty. A study of thirty patients. J Bone Joint Surg Am. 1966;48:339–348.

32. Morris JM, Lucas DB, Bresler B. Role of the trunk in stability of the spine. J Bone Joint Surg Am. 1961;43:327.

33. Loynes RD. Scoliosis after thoracoplasty. J Bone Joint Surg Br. 1972;54:484–498.

34. Bal S, Elshershari H, Celicer R, Celiker A. Thoracic sequels after thoracotomies in children with congenital cardiac disease. Cardiol Young. 2003;13:264–267.

35. Bleiziffer S, Schreiber C, Burgkart R, Regenfelder F, Kostolny M, Libera P, Holper K, Lange R. The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. J Thorac Cardiovasc Surg. 2004;27:1474–1480. DOI: https://doi.org/10.1016/j.jtcvs.2003.11.033

36. Ruiz-Iban MA, Burgos J, Aguado HJ, Diaz-Heredia J, Roger I, Muriel A, Sanchez PA. Scoliosis after median sternotomy in children with congenital heart disease. Spine (Phila Pa 1976). 2005;30:E214–E218. DOI: https://doi.org/10.1097/01.brs.0000158959.91925.43

37. Herrera-Soto JA, Vander Have KL, Barry-Lane P, Woo A. Spinal deformity after combined thoracotomy and sternotomy for congenital heart disease. J Pediatr Orthop. 2006;26:211–215. DOI: https://doi.org/10.1097/01.bpo.0000218527.36362.76

38. Herrera-Soto JA, Vander Have KL, Barry-Lane P, Myers JL. Retrospective study on the development of spinal deformities following sternotomy for congenital heart disease. Spine (Phila Pa 1976). 2007;32:1998–2004. DOI: https://doi.org/10.1097/BRS.0b013e318131b225

39. Feiz HH, Afrasiabi A, Parvizi R, Safarpour A, Fouladi RF. Scoliosis after thoracotomy/sternotomy in children with congenital heart disease. Indian J Orthop. 2012;46:77–80. DOI: https://doi.org/10.4103/0019-5413.91639

40. Mery CM, Guzman-Pruneda FA, De Leon LE, Zhang W, Kuo FH, Carpenter KL, Stringer LD, Adachi I, Heinle JS, McKenzie ED, Fraser CD Jr, Hanson DS. Risk factors for development and progression of scoliosis after pediatric cardiothoracic operations. Ann Thorac Surg. 2018;105:1835–1841. DOI: https://doi.org/10.1016/j.athoracsur.2018.01.017

41. Kaito T, Shimada M, Ichikawa H, Makino T, Takenaka S, Sakai Y, Yoshikawa H, Hoashi T. Prevalence of and predictive factors for scoliosis after surgery for congenital heart disease in the first year of life. JB JS Open Access. 2018;3:e0045. DOI: https://doi.org/10.2106/JBJS.OA.17.00045

42. Eby SF, Hilaire TS, Glotzbecker M, Smith J, White KK, Larson AN. Thoracogenic spinal deformity: a rare cause of early onset scoliosis. J Neurosurg Spine. 2018:29:674–679. DOI: https://doi.org/10.3171/2018.4.SPINE171389

43. Kerr HL, O’Callaghan J, Morris S. Progression of infantile scoliosis after thoracotomy and sternotomy for the treatment of congenital cardiac abnormalities. Spine Deform. 2023;11:635–641. DOI: https://doi.org/10.1007/s43390-022-00633-2

44. Balubaid RN, Aljedani RS, Moglan A, Hennawi YB, Mousa AH, Alosaimi M. Prevalence of spinal deformity development after surgical management of a congenital heart disease among children: a systematic review and meta-analysis. Eur Spine J. 2024;33:2088–2096. DOI: https://doi.org/10.1007/s00586-023-08083-8

45. Kawamura I, Yamaguchi T, Yanagida H, Tominaga H, Yamamoto T, Ueno K, Taniguchi N. Factors contributing to severe scoliosis after open chest surgery for congenital heart disease: a case-control analysis. Spine Deform. 2025:13:441–448. DOI: https://doi.org/10.1007/s43390-024-01009-4

46. Durning RP, Scoles PV, Fox OD. Scoliosis after thoracotomy in tracheoesophageal fistula patients. A follow-up study. J Bone Joint Surg Am. 1980;62:1156–1159.

47. Gilsanz V, Boechat IM, Birnberg FA, King JD. Scoliosis after thoracotomy for esophageal atresia. AJR Am J Roentgenol. 1983;141:457–460. DOI: https://doi.org/10.2214/ajr.141.3.457

48. Westfelt JN, Nordwall A. Thoracotomy and scoliosis. Spine (Phila Pa 1976). 1991;16:1124–1125. DOI: https://doi.org/10.1097/00007632-199109000-00019

49. Wong-Chung J, France J, Gillespie R. Scoliosis caused by rib fusion after thoracotomy for esophageal atresia. Report of a case and review of the literature. Spine (Phila Pa 1976). 1992;17:851–854. DOI: https://doi.org/10.1097/00007632-199207000-00024

50. Mishra PR, Tinawi GK, Stringer MD. Scoliosis after thoracotomy repair of esophageal atresia: a systematic review. Pediatr Surg Int. 2020;36:755–761. DOI: https://doi.org/10.1007/s00383-020-04683-3

51. Sacco R, Bonnevalle M, Nectoux E, Fron D, Ould-Slimane M, Sharma D, Lucchesi G, Canavese F. Thoracogenic scoliosis: a retrospective review of 129 pediatric patients with a mean follow-up of 10 years. Eur Spine J. 2022;31:2287–2294. DOI: https://doi.org/10.1007/s00586-022-07242-7

52. Beals RK, Robbins JR, Rolfe B. Anomalies associated with vertebral malformations. Spine (Phila Pa 1976). 1993;18:1329–1332. DOI: https://doi.org/10.1097/00007632-199308000-00012

53. Казарян И.В., Виссарионов С.В. Сочетание врожденных деформаций развития позвоночника у детей с аномалиями развития других органов и систем. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2012;2(3):88–93. [Kazaryan IV, Vissarionov SV. Cogenital spinal deformity and associated anomalies in children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2012;2(3):88–93]. EDN: https://elibrary.ru/PRULNX

54. Prybis BG, Pugh L, Stasikelis PJ. Cardiac screening in congenital spine disorders. J Pediatr Orthop. 2007;27:123–125.

55. Campbell M, Reynolds G. The physical and mental development of children with congenital heart disease. Arch Dis Child. 1949;24:294–302. DOI: https://doi.org/10.1136/adc.24.120.294

56. Mehrizi A, Drash A. Growth disturbance in congenital heart disease. J Pediatr. 1962;61:418–429. DOI: https://doi.org/10.1016/s0022-3476(62)80373-4

57. Nice CM Jr, Daves ML, Wood GH. Changes in bone associated with cyanotic congenital cardiac disease. Am Heart J. 1964;68:25–31. DOI: https://doi.org/10.1016/0002-8703(64)90235-2

58. Linde LM, Dunn OJ, Schireson R, Rasof B. Growth in children with congenital heart disease. J Pediatr. 1967;70:413–419. DOI: https://doi.org/10.1016/s0022-3476(67)80139-2

59. Bayer LM, Robinson SJ. Growth history of children with congenital heart disease. Am J Dis Child. 1969;117:564–572. DOI: https://doi.org/10.1001/archpedi.1969.02100030566011

60. White RI Jr, Jordan CE, Fischer KC, Dorst JP, Nagy JM, Garn SM, Neill CA. Delayed skeletal growth and maturation in adolescent congenital heart disease. Invest Radiol. 1971;6:326–332. DOI: https://doi.org/10.1097/00004424-197109000-00006

61. White RI Jr, Jordan CE, Fischer KC, Lampton L, Neill CA, Dorst JP. Skeletal changes associated with adolescent congenital heart disease. Am J Roentgenol. 1972;116:531–538. DOI: https://doi.org/10.2214/ajr.116.3.531