A contemporary approach to surgical treatment of scolioses

Scoliosis belongs to the most frequent deformations of human axial skeleton. In about 20% of cases, the pathology constituting the original cause of scoliosis is recognized. As regards the remaining cases, the diagnosis of scoliosis idiopathica is made by way of elimination. For many years, surgery has been the standard procedure in the treatment of large scolioses, where preservative treatment proves ineffective. The aim of the work is to present contemporary opinions and controversies concerning the indications for surgical treatment of scoliosis, the choice of surgical access, modern possibilities and evolution of surgical methods employed for correction and stabilization of scoliosis. Therapeutic decisions taken after scoliosis has been diagnosed are based on clinical and radiological assessment of a number of factors having a documented influence on the risk of progression of the curvature. General indications for surgical treatment of scoliosis include progressing scoliosis of Cobb’s angle over 40-45° in skeletally immature children, considerable deformations of Cobb’s angle over 50° in adolescents, irrespectively of their skeletal age, scoliosis-related pain complaints unresponsive to preservative treatment, thoracic lordosis coexisting with progressive scoliosis, and cosmetic deformations. In scolioses of known etiology, the decision of surgical treatment is influenced not only by the factors of progression risk, common to idiopathic scolioses and related to growth potential and extent of the deformation, but also by additional factors, specific to the original pathology underlying the scoliosis, e.g. the type, number, and location of congenital defects in the spinal area in congenital (osteopathic) scoliosis, the dynamics and type of neurological disorders in neuropathic scoliosis. The origin of the modern spinal surgery was a combination of the concept of spinal fusion and inner stabilization and correction of the scoliosis with spinal implants. In consideration of the patient’s age, morphology of the scoliosis, as well as the operator’s experience and preferences, a choice is made between spondylodesis and anterior or posterior stabilization, or a combination of the two. Among the contemporary surgical methods, two different approaches can be distinguished with respect to the patient’s age: correction and stabilization of scoliosis with an application of implants and spinal fusion, and stabilization and correction of scoliosis, utilizing the remaining growth potential for curbing the progression and directing further spinal growth until final spondylodesis is applied. In spite of enormous progress in spinal surgery that has been made over the last hundred years, the main objective of surgical treatment of scoliosis has remained the same: an optimal and permanent correction of the deformation with the least possible complications.