ABSTRACT
Spinal fusion is also referred to as arthrodesis, a word coming from ancient Greek, which indicates the link between two articular surfaces. It has always been one of the most important achievements for vertebral surgery. The history of the treatment of idiopathic scoliosis is emblematic. Initially, this condition was mainly treated by orthopedic doctors with special beds/frames very similar to medieval torture instruments. The spine was pulled along its longitudinal axis and the hump was put under pressure. In more recent times, the correction has been maintained by applying very large casts covering the whole trunk and the pelvis. This treatment induced spectacular corrections, which, however, disappeared and the patients went back to their original situation once the cast was removed. For this reason, some “old generation” orthopedic doctors referred to scoliosis as “orthopedic cancer.” In fact, it seemed that this was an incurable and progressive disease, which led to very severe deformities that were incompatible with vital functions. In the most severe cases, this disease led to respiratory distress and death. It was only after the introduction of spinal fusion that the surgical treatment of scoliosis led to hope and life. This exceptional progress was crafted by the American surgeon Hibbs (Fig. 14.1). At the turn of the century, he experimented the efficacy of bone fusion in a series of cases of bone tuberculosis (Pott’s disease). He had the brilliant idea of applying this treatment to scoliosis. It was an extraordinary success that marked the beginning of further changes to this technique, with innumerable improvements until today. Hibbs’
technique was designed to apply the autologous bone taken for the same patient, generally the iliac bone, to the posterior spine, after dissecting and bleeding the laminae and any part of the posterior arch especially at the level of the concave aspect of the curve. The correction was then maintained with casts until bone fusion was obtained. This entailed a lot of suffering for young women who were obliged to wear the cast for a very long time before and after the procedure. A frequent complication was pseudo-arthrosis (non-union), with the immediate consequence of losing the correction and of creating an imbalance at the level of the coronal and of the sagittal plane. So the patients had to undergo revision surgery with the application of an additional autologous graft and post-operative immobilization. On the one hand, a solution had been found to correct these deformities, but, on the other, this led to an enormous existential sacrifice in subjects at the most sensitive and difficult time of adolescence. Some decades went by before surgery had a major quality jump. The American surgeon P. Harrington [1, 2] (Fig. 14.2) systematically introduced the internal fixation of the spine to correct deformities. The Harrington Instrumentation rapidly spread around the world and immediately attracted the scientific community for its extraordinary potential for young patients suffering from deformities. Harrington had the courage to use steel rods and hooks to fix the spine, which had never been violated with external techniques, being the “custodian” of the noble and delicate structures that allow for motor function (the bone marrow and cauda equina). However, he did not take into consideration the past experience of Hibbs. As a result, the procedure had a high incidence of non-unions and many failures. It was John Howard Moe (Fig. 14.3), the founding member and first president in 1966 of the Scoliosis Research Society, who combined the two methods into a single procedure called “internal fixation and spinal fusion.” Paul Harrington said about him, “John Moe was the father of modern-day treatment of scoliosis.”
