History of surgery for the correction of spinal deformity

Abstract

During the last century the technological advances in the field of spinal surgery had a dramatic impact on the treatment of spinal deformity in children and adults. Before the advent of medications and vaccines to treat and/or prevent tuberculosis and poliomyelitis, patients suffering from these disorders often became incapacitated by the resulting kyphoscoliosis. In the early 1900s Lange began to address this problem mechanically by using foreign materials to stabilize the spine internally. In the 1950s and 1960s, owing to the efforts of Harrington and others, the process evolved to create the first generation of modern spinal instrumentation. The Harrington rod was able to correct a spinal deformity primarily through distraction. In the next wave of advances, some of the shortcomings of Harrington rods were addressed. Segmental fixation involving sublaminar wires was introduced in the 1970s by Luque. Anterior approaches and instrumentation-related techniques developed by Zielke and colleagues as well as Dywer and coworkers in the late 1960s and mid-1970s allowed for better correction of deformity with immobilization of fewer motion segments compared with posterior surgery. Transpedicular fixation of the spine was popularized by Cotrel and Dubousset in the 1980s; they used the technique to perform segmental stabilization, which better reduces the rotational aspect of a deformity. Finally, in the mid-1990s, thoracoscopic techniques were developed and are currently in use for anterior release and placement of instrumentation. The authors review the major technical developments for the surgical treatment of spinal deformity.