Congenital spinal deformities (CSDs) are rare but severe conditions caused by abnormalities in vertebral development during embryogenesis. These deformities, including scoliosis, kyphosis, and lordosis, significantly impair patients’ quality of life and present challenges in diagnosis and treatment. This review integrates genetic, molecular, and developmental insights to provide a comprehensive framework for classifying and understanding CSDs. Traditional classification systems based on morphological criteria, such as failures in vertebral formation, segmentation, or mixed defects, are evaluated alongside newer molecular-genetic approaches. Advances in genetic technologies, including whole-exome sequencing, have identified critical genes and pathways involved in somitogenesis and sclerotome differentiation, such as TBX6, DLL3, and PAX1, as well as key signaling pathways like Wnt, Notch, Hedgehog, BMP, and TGF-β. These pathways regulate vertebral development, and their disruption leads to skeletal abnormalities. The review highlights the potential of molecular classifications based on genetic mutations and developmental stage-specific defects to enhance diagnostic precision and therapeutic strategies. Early diagnosis using non-invasive prenatal testing (NIPT) and emerging tools like CRISPR-Cas9 gene editing offer promising but ethically complex avenues for intervention. Limitations in current classifications and the need for further research into epigenetic and environmental factors are discussed. This study underscores the importance of integrating molecular genetics into clinical practice to improve outcomes for patients with CSDs.

Background: Iatrogenic hallux varus is a rare but functionally disabling complication most commonly following hallux valgus surgery. Traditional revision techniques, such as tendon transfer or arthrodesis, may compromise joint mobility or require implants. This study evaluates a biologically autologous alternative—local soft tissue myoligamentoplasty—for the correction of flexible deformities. Methods: A retrospective case series of seven patients (mean age 62 years) with flexible iatrogenic hallux varus following prior hallux valgus surgery was conducted at a single tertiary care center. All patients underwent local soft tissue myoligamentoplasty using an F-shaped medial capsular flap and lateral release via a double-incision approach. Outcomes were assessed using the Visual Analog Scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) hallux score, and radiographic measurements (hallux valgus angle [HVA], intermetatarsal angle [IMA]) over a 12-month follow-up. Results: Mean VAS improved significantly from 6.1 ± 1.2 preoperatively to 1.4 ± 0.8 at 12 months (p < 0.01), and AOFAS scores increased from 47.6 ± 6.9 to 83.7 ± 7.1 (p < 0.01). HVA was corrected from −15.4° ± 4.3° to 2.7° ± 3.8° (p < 0.01), while IMA remained unchanged (10.3° ± 1.9° to 9.8° ± 2.1°, p = 0.12), indicating mechanical neutrality. No recurrences, reoperations, or complications were reported. Patient satisfaction was high, with 5/7 “completely satisfied” and 2/7 “satisfied with minor concerns.” Conclusion: Local soft tissue myoligamentoplasty offers a safe, effective, and joint-preserving surgical option for correcting flexible iatrogenic hallux varus. The technique provides durable pain relief, functional improvement, and cosmetic restoration without the need for tendon harvesting or implants, making it especially suitable for patients with preserved joint surfaces or in resource-limited settings.