A brief overview of 100 years of history of surgical treatment for adolescent idiopathic scoliosis

Abstract

The history of surgical correction for adolescent idiopathic scoliosis reaches back about 100 years: the natural course of progressive, crippling and sometimes even life-threatening deformities which could not be controlled by external means called for effectual, invasive procedures. Hibbs 1911 aimed at halting progression by long, uninstrumented fusions. However, the lack of true correction, long rehabilitation times, high pseudarthrosis and infection rates, and a fusion mass which bent further once exposed to gravity again were not satisfying. The transition from slowing progression to halting progression and truly correcting the deformity lasted almost another half a century: Paul Harrington, confronted with many scoliotic polio patients, successfully introduced a hook-rod system for concave-distraction and convex-compression at the end of the 1950s. Many implant failures, a still-considerable pseudarthrosis rate, flattening of the sagittal profile and the lack of true three-dimensional (3D) correction were the shortcomings. In the 1970s the Frenchmen Cotrel and Dubousset took scoliosis surgery to the next level by introducing a versatile hook system and curve-pattern-adapted correction modes. The basics of the so-called derotation-manoeuvre consists in strategic distribution of the anchors along the curve, bending the rod accordingly, and rotating it back into the sagittal plane. The overall correction, stability and the fusion rates improved significantly. However, the effect on the sagittal and transverse plane were still limited. Lately, a better biomechanical understanding and bilateral, polysegmental strong three-column fixation with pedicle screw has become the benchmark method: in conjunction with posterior release techniques, osteotomies or even vertebral column resections for severe cases, it allows better 3D control (vertebral column manipulation), faster rehabilitation and better patient satisfaction.

Keywords: Adolescent; History; Idiopathic scoliosis; Surgery.

Fig. 1

40-year-old woman with a 26-year follow-up after single Harrington distraction rod instrumentation. Uneventful fusion occurred and the uninstrumented lumbar spine remained stable over time. Slight loss of balance to the left in the coronal plane (a). In the lateral view (b) loss of balance in posterior direction, flattening of the instrumented thoracic spine and a significant rib hump are present

Fig. 2

a 13-year-old girl with fast progressive adolescent idiopathic scoliosis. 95° main right thoracic and compensatory 60° left lumbar curve with 3 cm loss of trunk balance to the right and shoulder imbalance. Clinically 30° rib hump and 20° lumbar prominence. b The lateral view displays a hypokyphotic thoracic profile and the significant rib hump. c To prevent primary long fusion to L4, it was decided to selectively instrument and fuse the thoracic spine from T3 to L1 with a hook-wire-screw hybrid construct. In view of the dysplastic concave mid-thoracic pedicles sublaminar classic Luque wires were used in combination with periapical convex pedicle screws. The right shoulder was pulled down with a pedicle hook-transverse process hook-claw construct and the left shoulder lifted with pedicle hooks and slight distraction. Solid thoracolumbar pedicle screw foundation bilaterally. Two years postoperatively, well balanced trunk, with a 30-30° right thoracic-left lumbar double curve and leveled shoulders. d The lateral view shows a residual, but improved rib hump and a normalized sagittal profile