[Contemporary view on the treatment of deformities of the spine.]

The author draws attention to errors which are still encountered in the treatment of deformities of the spine, and to recent findings. In conservative as well as surgical treatment of scolioses little attention is paid to curvatures in the sagittal plane. Thoracic hypokyphosis is relatively frequent, it has a significant impact on pulmonary functions, it reduces the effectiveness of orthosis and plays also a significant role in the indication for surgery. Conservative treatment involves the wearing of an orthosis, physical exercise and other rehabilitation procedures do not affect the curvature. Correct indication, effective orthosis and a correct therapeutic regimen are essential. If, however, the curvature does not respond to orthosis it is necessary to operate regardless of age. In some deformities it is useless to attempt treatment by orthosis, surgery is necessary immediately. Frequently the essential continuation of conservative and surgical treatment is lacking due to the decision of a department which tries to use only orthosis, although there is progression of the curvature. Frequently the progression of the curvature is due to low-standard orthesis. The result of the conservative procedure is considered satisfactory where after completed growth the value of the curvature is equal to that at the onset of treatment. In recent years some authors hold the view that treatment by orthesis is useful only when started during the prepubertal period; with the onset of menstruation it is no longer meaningful because during that period its effectiveness declines briskly. According to contemporary knowledge in idiopathic scolioses surgery should be considered when the values are about 40 degrees , moreover, we take into account the degree of rotation and possible presence of thoracic hypokyphosis. Contemporary surgical techniques of segmental instrumentation permit correction of idiopathic curvatures above 50 degrees . Stiffer and more severe curvatures, however, call for longer preoperative preparation, relaxing operations such as thoracic discectomy or procedures in the thoracolumbar and lumbar spine, a combination of Zielke's anterior operation with some posterior segmental instrumentation. Decision on the most suitable surgical system and extent of instrumentation is governed by an effort to preserve as many mobile segments in the lumbar spine as possible. The classification according to King et al. and a suitable surgical system frequently make it possible to meet this demand.