30845 Suppl Giot.pdf - Giornale Italiano di Ortopedia e Traumatologia

Past, present and future for spinal deformities
out fusion experimented and developed for growing spine and
attached directly to the spine or to the ribs and must be reserved
to a few centers well controlled and trained in order to obtain
sufficient number of cases, sufficient data, and subsequently reliable
results.
The last revolution is not yet here, but “on the way ”it will touch
mainly 2 research fields:
a) the etio-pathogeny of idiopathic scoliosis where numerous
researches are done in multiple laboratories all over the
world and seems to converge, as we can observe thanks to
the Yves Cotrel Foundation, toward a probably genetic central
neurological or neuro-hormonal disorder in relation with
the erect posture characteristic of the human nature. It exist
always a competition between the researchers, for those
looking the inducing factor to be determined and the others
looking for factors favouring progression of the deformity.
b) The nature and prevention of aging deterioration at the
level of the spine, mainly turned toward prevention of
osteoporosis,as well as minimize as much as possible degenerative
changes at the spinal unit level, disc, facets, and surrounding
muscles.
S184
Conclusion: each patient is unique.
Analyse precisely the reasons he had to see you.
Make a diagnosis as precise as possible, locally but always
regarding the entire spine.
Choose the proper indication for treatment non operative or
operative, measuring always the balance benefit/risk.
In a child decide early on a localized pathology accessible for
correction (ex.: congenital hemivertebra) to prevent worsening
by growth.
But if the pathology concern the entire thoracic segment (ex
infantile idiopathic), be careful, favour a prolong casting and
bracing treatment ending sometimes by fusion and instr. at adolescence,
rather than diving early in hazardous surgery, factor of
repeated scars and complications (“don’t put the finger in!”).
In an old person follow her regularly, decide with calm and and perfect
weighing the balance benefits/risks, but having in mind to decide
not too late when the general status of the patient declining will lead
to more hazardous vital or post anaesthesia brain confusion result.
One cannot pass his own experience, but, one’s thought always
open ways for others.