Abstract
Deformities of the spine occur as a consequence of a number of different
aetiologies each with a differing pathogenesis and natural history. The resulting
deformity may be a scoliosis which is a lateral curvature of the spine in the frontal
plane, a kyphosis which is an abnormal posterior curvature in the sagittal plane or a
kyphoscoliosis which is a combination of both deformities. Significant progression
of the curvature can occur with spinal growth and result in a very severe deformity
with a major effect on general health, longevity and quality of life. If the deformity
develops and progresses in early childhood, it can result in an impairment of lung
growth and development possibly leading to cor pulmonale and death in early adult
life. A kyphosis or kyphoscoliosis can cause spinal cord compression and if left
untreated can result in paraplegia. Some patients develop back discomfort in later
life, due to secondary degenerative arthritic changes, and others have a reduced selfimage leading to psychological disturbances. Knowledge of the natural history is
essential in anticipating problems and is the benchmark by which treatment is
evaluated.
This collection of work is based on my studies of the aetiology, pathogenesis,
natural history and management of patients with deformities of the spine seen over a
period of 35 years while working as a spinal surgeon in Edinburgh.
In 1975, I was appointed Senior Lecturer and Consultant Orthopaedic Spine
Surgeon, working with Prof. J I P James in the Department of Orthopaedic Surgery,
University of Edinburgh. It was here that I was able to establish a large database of
patients, especially those with congenital deformities of the spine, who had
previously received little or no treatment. This provided me with invaluable
information and stimulated my lifelong interest in the natural history and allowed me
to formulate an appropriate course of management for these conditions. In 1978,
when Prof. James retired I took over his clinical practice and established the
Edinburgh Spine Deformity Centre which later became, under my directorship, the
Scottish National Spine Deformity Centre treating all patients from the whole of
Scotland.
At present there is virtually no severity of spinal deformity which cannot be
significantly improved by surgery. However, it should be recognized that the
necessity for surgical salvage procedures at a late stage, to correct severe deformities
for conditions commencing as minor curves in infancy or adolescence, indicates a
failure of management. This thesis emphasizes the need for early detection and
prevention of severe deformity and depends on a thorough knowledge of the
pathogenesis and natural history of the various conditions which can produce a
scoliosis, kyphosis or kyphoscoliosis.