OrthoBuzz regularly brings you a current commentary on a “classic” article from The Journal of Bone & Joint Surgery. These articles have been selected by the Editor-in-Chief and Deputy Editors of The Journal because of their long-standing significance to the orthopaedic community and the many citations they receive in the literature. Our OrthoBuzz commentators highlight the impact that these JBJS articles have had on the practice of orthopaedics. Please feel free to join the conversation about these classics by clicking on the “Leave a Comment” button in the box to the left.
Michael McMaster, a widely respected and well-published orthopaedic surgeon from Edinburgh who treated a great number of pediatric spinal deformity patients over a 36-year career, published this classic JBJS article more than 30 years ago. His report continues to serve as the basis for what we as pediatric spinal deformity surgeons recommend for treatment in children with congenital scoliosis. The classification that he proposed allows us to know early in childhood which congenital scoliosis patients require early, aggressive treatment and who can be followed with little need for treatment.
By assessing 251 growing patients with congenital scoliosis in a longitudinal manner, Mr. McMaster determined the rate of progression with growth for 5 different primary curve types. The most progressive deformity is a unilateral vertebral bar (failure of segmentation) with a contralateral hemivertebra (failure of formation). Common congenital single hemivertebrae worsen most in the thoracolumbar and lower thoracic areas, and all hemivertebrae progress at a faster rate after 10 years of age than prior to age 10.
Knowing the natural history of any deformity in pediatric orthopaedics is the major factor in determining the need for treatment. Mr. McMaster here provided the pediatric spinal deformity surgeon with essential information that still guides our treatment of congenital scoliosis on a daily basis today.
Vernon T. Tolo, MD
JBJS Editor Emeritus