Past, present, and future in pediatric spinal surgery
According the almost 55 years of experience in Pediatric Spinal surgery it was easy for me to describe the evolution during the past of the surgical techniques as well as the indications for spinal deformities done first without any instrumentation (still useful from time to time nowadays), as from the back as on the front, post-operative immobilization achieved thanks to casting. The real instrumentation appeared successively with Harrington, Luque, and simultaneously the introduction of pedicle screw thanks Raymond Roy Camille. It was necessary to wait another 20 years to get the segmental 3D strategy of the CD instrumentation still the basis of modern spinal surgeries techniques whatever using Hooks Screws, Universal clamps or Hybrid constructs. For present & future, Early surgery is still indicated for localized lesion generally secondary to congenital malformations with or without spinal cord decompression. But for extended lesions especially involving the thoracic area cast and brace is still the good choice whatever the etiology with or without pelvic obliquity. When this treatment fails many attempts with various techniques were used with some success for spinal growth without disturbances about the respiratory function. But it was also demonstrated that the number of complications were still high, with in many cases the necessity to perform a final surgical fusion. It is why the development of the bipolar minimal invasive technique appeared, with very promising results, including the fact that a substantial number of patients get a spontaneous fusion, excluding final surgery. For the older or adolescent patients, the evolution toward a race to obtain the maximum correction of the Cobb angle become more and more disputable as is was demonstrated that the most important for the future regarding the spinal function is the 3D dynamic balance of the discs spaces left free below and above the fused area.