The Operative Treatment of Scoliosis

The problem of the complete correction or cure of structural scoliosis is still unsolved.Thus far treatment has been directed toward, and necessarily limited to, reducing the curvature, improving the appearance of the back and maintaining that improvement.There are various methods of treatment whereby improvement may be obtained in a large percentage of cases, but there is no known method which assures permanent results.To make sure that the correction will be lasting, we have been compelled to prolong the treatment over a period of from five to ten years.If a patient, after having undergone cor- rective treatment for several years, has retained the improvement and has shown no signs of relapse during an additional period of two or three years, we feel warranted in believing that the deformity will not increase.We can, however, at no time feel positive about this, for we all see cases become worse when treatment is interrupted, and some- times even while corrective treatment is in progress.The deformitymay even remain stationary for a number of years and then become more severe.I have seen scoliotic deformity increase during adult life.While, therefore, it is true that some cases remain mild and stationary, with or without treatment, the fact remains that in many- patients the deformity does become severe and that in any given instance we are unable to prognosticate the course or state with any assurance that the deformity has reached its greatest development.Some more certain method must, therefore, be found whereby a given spinal curvature can be fixed, so to speak, so that it will not increase.Such a method might then be applied in the earliest stages of the deformity and the many very severe curvatures of the paralytic, rachitic and razor-back variety might be prevented.Dr. Hibbs,1 encouraged by the results of his fusion operation in Pott's disease, reasoned that this operation ought to give satisfactory results in scoliosis.He has operated, we are told, in many cases, and believes that fusion of a part of the spine in scoliosis will prevent further increase of deformity.Dr. A. Mackenzie Forbes 2 also believes that fusion of the vertebrae will arrest the course of the deformity.