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