A perspective on recent trends for scoliosis correction

Area of Science:

• Orthopedic Surgery
• Spinal Biomechanics
• Scoliosis Deformity Correction

Background:

• Fundamental principles of scoliosis surgery established during the Harrington era remain relevant.
• Past surgical experience highlights the importance of vertebral selection, anterior release for rigid curves, and fusion techniques.

Purpose of the Study:

• To review advancements in scoliosis surgery over the last decade.
• To discuss the impact of biomechanical knowledge and three-dimensional deformity appreciation on surgical techniques and instrumentation.

Main Methods:

• Review of evolving surgical principles and instrumentation in scoliosis treatment.
• Analysis of biomechanical insights into segmental spinal instrumentation and dual-rod systems.
• Emphasis on the three-dimensional correction of scoliotic curves, including sagittal contour restoration.

Main Results:

• Biomechanical advances, including segmental instrumentation and linked rod systems, enhance spinal stiffness and implant durability.
• Improved understanding of three-dimensional scoliosis has led to better correction and preservation of sagittal alignment (kyphosis/lordosis).
• These developments have resulted in reduced correction loss and fewer pseudarthroses (failed fusions).

Conclusions:

• Modern scoliosis surgery builds upon established principles with enhanced biomechanical understanding and 3D correction strategies.
• New instrumentation systems offer improved outcomes but require careful selection based on their specific advantages, problems, and risks.
• Preserving or restoring sagittal contours is a critical aspect of successful scoliosis correction.