Congenital spinal deformities are among the most difficult deformities to
treat. They are a challenge both from a decision-making and a technical point
of view. Many deformities do not require any treatment short of investigation
and observation, but, at their worst, they will challenge the surgeon
technically and cognitively. The variety of combinations of congenital
deformities seems limitless and therefore makes the prediction about what will
happen with growth very difficult. In this article, the principles of
nonoperative and operative management will be discussed.