Prevalence and Clinical Correlates of Intraspinal and Vertebral Anomalies in Congenital, Adolescent Idiopathic, and New-Onset Scoliosis:

Objective: To explore the prevalence of and clinical associations between intraspinal and vertebral abnormalities in patients with congenital scoliosis (CS), adolescent idiopathic scoliosis (AIS), and early-onset scoliosis in Saudi Arabia. Methods: This retrospective cohort investigation included patients aged 18 years or younger diagnosed with CS, AIS, or new-onset idiopathic scoliosis who underwent full-spine magnetic resonance imaging between 2015 and 2025 at a tertiary center in Riyadh, Saudi Arabia. Clinical and radiological data were collected, and intraspinal and vertebral anomalies were classified. Statistical analyses included Chi-square, Fisher's exact test, and the Wilcoxon rank-sum test, with significance set at Results: A total of 127 patients fulfilled the inclusion criteria; idiopathic scoliosis accounted for 80.3% and CS for 19.7%. Intraspinal anomalies were identified in 7.9% of patients, with a higher prevalence in CS (24%) than in idiopathic scoliosis (3.9%). Low conus was the most common anomaly (40%). Vertebral defects in CS were mainly failures of formation (76%), most commonly hemivertebrae, predominantly affecting the thoracic spine. Congenital scoliosis was significantly associated with a higher incidence of intraspinal anomalies ( Conclusion: Intraspinal anomalies were substantially more common in CS than in idiopathic forms in this Saudi cohort, underscoring the importance of routine preoperative magnetic resonance imaging to guide risk assessment and surgical planning.