Surgical treatment of adolescent idiopathic scoliosis.

The surgical management of idiopathic scoliosis requires knowledge in several areas. In selecting patients for surgical care, it is necessary to know the natural history for the type of curve present during the teenage years, as well as what can be expected of this type of curve during adult life. Preoperative evaluation must include screening for other than idiopathic causes before surgery is advised. Appropriate attention to preoperative radiographs, possible autologous blood utilization, and planning for spinal cord monitoring are essential. Finally, the ability to use a variety of techniques in spinal deformity surgery is needed, as is the knowledge of which technique or instrumentation is best in each situation. Although the surgical care of spinal deformity has become more complex and requires attention in several areas, the advances in surgical care and in spinal instrumentation allow us to correct spinal deformity more safely and predictably in a more three-dimensional manner than was feasible even a decade ago.