Congenital anomalies of the vertebrae producing a scoliosis, kyphoscoliosis or kyphosis are potentially serious conditions, which can, on occasion, result in an extremely severe rigid spinal deformity with possible spinal cord compression. The key to successful management depends on: (1) Early diagnosis while the curve is still small. (2) Anticipation of the likely prognosis based on the type and site of the vertebral anomaly, the degree of growth imbalance it produces and the amount of spinal growth remaining. (3) Preventing progression of the deformity and this may necessitate surgical treatment in the first few years of life. It is much better to carry out a relatively simple operation to balance the growth of the spine at an early stage than to wait and perform potentially hazardous anterior and posterior spinal surgery as a salvage procedure at a later stage.