FOREWORD

Abstract

FigureThe treatment of thoracolumbar spinal deformity has traditionally been the purview of the orthopedic surgeon. Early specialization in deformity management arose primarily out of the need to treat postinfectious sequelae and idiopathic scoliosis in adolescents, who were managed primarily in infection wards and childrens' hospitals. Thus, a body of experience was amassed and refined in these environments, with the emphasis on biomechanics, spinal fixation, and arthrodesis. Traditionally, these areas had received less emphasis in neurosurgical education. The modern era has witnessed an increasing population of patients harboring degenerative, post-traumatic, and iatrogenic spinal deformities. Spinal deformity is also frequently associated with conditions such as syringomyelia, diastomyelia, myelomeningocele, and spinal cord tumors, patients who often come under the care of a neurosurgeon. Improvements in anesthetic and intensive care, along with advances in spinal instrumentation and imaging, have made the treatment of these complex pathologies more accessible to neurosurgeons. An assortment of other forms of deformity, including adolescent idiopathic scoliosis, have been increasingly treated by neurosurgeons with subspecialty interests in complex spinal surgery. In addition, neurosurgeons have begun to develop the necessary skills to perform complex spinal reconstructions which maintain or re-establish proper sagittal and coronal alignment. In this supplement to NEUROSURGERY, we have addressed some of the critical topics in thoracolumbar deformity surgery. While not intended to be comprehensive, this supplement should serve as an introduction to the evaluation and management of these complex patients. The first section begins with an overview of the history of spinal deformity and concludes with a new and practical methodology for classifying these pathologies. This is followed by a section addressing issues related to patient selection and decision making, which are critical in the preoperative stage. The third section reflects the myriad etiologies of deformity, with chapters on special pathologies and patient populations, followed by a section on specific techniques for spinal fixation and deformity reduction available to the contemporary neurosurgeon. The supplement concludes with an assessment of some of the emerging technologies in genetic testing, minimally invasive approaches, and growth modulation surgery. Included with this issue is a DVD with videos on specific deformity correction methods to introduce the reader to some of the techniques currently employed. Whether for the prevention of iatrogenic deformity, the management of challenging curvatures, or as an introduction to emerging technologies, we hope this supplement will be engaging for neurosurgeons treating spinal disorders. Robert F. Heary Newark, NJ Christopher I. Shaffrey Charlottesville, VA Michael Y. Wang Miami, FL