Four Decades of Advancement for the Surgical Treatment of Spinal Deformity

My passion for the surgical correction of spinal deformity started during my residency in Toronto at the Hospital for Sick Children. I was fortunate to rotate through the service of Dr. John Hall a master surgeon and a visionary. Previously, he had introduced spinal instrumentation to Toronto, Canada after visiting Dr. Paul Harrington in Houston to observe a scoliosis correction with the Harrington distraction and compression rod systems. Dr. Hall was one of the first converts to spinal instrumentation with arthrodesis to correct and stabilize scoliosis. Later, the indications were broadened to include kyphosis as well as other spinal deformities. Typical of Hall, he recognized the advantages of implants that provide internal correction and increased stability to the spine. Meanwhile most others rejected instrumentation as an unnecessary risk and stuck to the standard of care of that time: cast correction arthrodesis through the cast and followed by six months recumbency in cast. Typically, Hall mastered the technique, simplified it and taught this to the many surgeons that visited his operating room. Further, he taught, lectured and published extensively. Dr. Hall was also one of the early converts to anterior instrumentation for thoracolumbar curves. The anterior and retroperitoneal approaches to the spine for deformity were techniques that spinal surgeons learned from Alan Hodgson of Hong Kong who popularized this approach for the surgical debridement of spinal tuberculosis. Later, Hodgson and Alan Dwyer from Australia collaborated on a technique for anterior surgical correction of scoliosis. Soon after that, Hall invited Hodgson to Toronto and I was again fortunate to scrub with both of them for the first anterior scoliosis surgery done in Canada using the Dwyer cable system. Though I didn’t recognize it the time, I was witnessing the beginning of a modern era for the surgical treatment of spinal deformity; a paradigm shift from an earlier time when treatment based on anecdotal experience instead of data derived from research. Further, treatment techniques had not changed for many decades. I was a witness to a change that moved spinal surgery towards a new way level of treatment techniques and eventually clinical and laboratory research. This was the beginning of a new subspecialty within orthopaedic surgery devoted to solving the problems of the deformed spine. Initially, this change occurred because of the vision of a few men including Paul Harrington, John Moe and John Hall. With time, more would join this small group to further drive this subspecialty forward. Ultimately, it became apparent to these visionary surgeons that a mechanism was needed to encourage further discussion and the exchange of ideas for the treatment of spinal deformity. Research and the dissemination of information was their goal.