Minimally invasive treatment of spinal deformity

There has been a rapid evolution in the operative management of spinal deformity during the past century. While much has changed in the surgical theater, the goals of treatment have remained the same: to achieve balanced curve correction, obtain solid arthrodesis, prevent future deformity, improve and/or prevent back pain, and avoid cardiopulmonary compromise [1]. In the first half of the twentieth century, the standard of care was posterior arthrodesis followed by prolonged bed rest and casting [2]. In the late 1950s, Harrington introduced instrumentation to achieve improved curve correction, lower pseudarthrosis rates, and allow early patient mobilization. Harrington utilized a nonsegmental system to distract across the concave side of a curvature and, in doing so, elongated the spine [3]. The coronal plane correction achieved was desirable, but the sagittal plane distraction forces resulted in a loss of lumbar lordosis and flat back syndrome in many patients [4].