Thoracolumbar spinal deformity: Part I. A historical passage to 1990

Historical vignette

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Seven millennia of anthropological artifacts and historical tales reference human spinal deformity, its diagnosis, and treatment—many of the latter of which turned out to be worse than the deformity itself. From Hippocrates to Harrington to the 21st century, the literature base has expanded in exponential fashion to yield an imperfect but constantly improving body of evidence, experience, and understanding of this challenging disease phenomenon. This review details the pre-1990 innovations, whose failures and successes have equally contributed to the advancement and dissemination of the increasingly evidence-based field of spinal deformity.

Article Information

Address correspondence to: Adam S. Kanter, M.D., University of Pittsburgh–Presbyterian, 200 Lothrop Street, Suite B-400, Pittsburgh, Pennsylvania 15213. email:

† Deceased December 12, 2008.

© AANS, except where prohibited by US copyright law.



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    Photographs of key figures in the evolution of the treatment for scoliosis (left to right): Hippocrates, Galen, Ambroise Paré, Russell Hibbs, Joseph Risser, John Cobb, John Moe, Paul Harrington, Alan Dwyer, Klaus Zielke, Yves Cotrel, Jean Dubousset.

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    Photograph of the Hibbs and Risser turnbuckle cast with hinges in the orthogonal planes to generate traction and bending forces to maximize pre- and postoperative correction.

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    Radiographs depicting chest wall deformities created by the localizing forces of the immobilizing casts, which proved to be more detrimental to the patients pulmonary status than the spinal deformity itself.

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    Photograph of Walter Blount (left) and Albert Schmidt (right) who introduced the Milwaukee Brace in the early 1950s, a revolutionary removable distraction jacket for the treatment of progressive idiopathic spinal deformity.

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    Harrington's fixation techniques yielded superior deformity correction over casting measures but at the expense of surgical complications in as many as 15% of patients. Photograph of one such complication: a mechanical hardware failure.

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    Photographs of Dwyer's segmental cable compression system, which enabled short construct curvature correction via titanium vertebral screws along the convexity of the curve through which a threaded cable applies compressive forces.

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    In the early 1970s, Luque introduced the concept of vertebral load sharing via segmental stabilization. Drawing illustrating sublaminar wires affixed to parallel rods and crossbars providing added strength, rotational control, and biomechanical durability.

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    Drawing showing how Cotrel and Dubousset combined a hook and rod system with transpedicular screws to provide 3-column fixation. The system thus enables total segmental rotation, compression, and distraction prior to biological fusion.


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