Lessons from the past: pathways to the future

Abstract

A famous American surgeon, A. Bruce Gill, once said “Study principles, not methods. A mind that understands principles can devise its own methods.” Here I discuss 10 basic principles in the field of spinal deformity treatment that have strong messages from the past and apply equally to the future. Principle 1: Progressive curves must be stopped by bracing or surgery — there is no excuse for procrastination That spinal curves must be stopped from progressing by bracing or surgery is a very old principle, and we should not even have to mention it in this era, but the problem still exists. Sometimes the problem lies with the general practitioner who does not understand the seriousness of a child with a unilateral unsegmented bar and fails to refer the child promptly to a spine specialist. Only when the curve has progressed severely does the referral come, and then it is too late. This is a problem of educating our medical colleagues. Sometimes the problem is with the spine surgeon who either fails to recognize the serious nature of the problem or fails to measure the films carefully to detect the progression. Sometimes there is simply a reluctance to operate on a 1-year-old child for fear of “stunting the child’s growth.” Letting a curve progress severely gives far more torso shortening than would early fusion.