Growth modification in the treatment of scoliosis.

Structural deformities, of which scoliosis is a notable example, imply a skeletal length discrepancy which may involve all three dimensions. Once the deformity is established, secondary mechanisms come into action. Physiological treatment concerns modifying spinal growth and the convex side can be retarded, the concave side stimulated, the neurocentral physis arrested to correct rotation, and the forces acting along the ribs can be altered. Thus stapling, epiphysiodesis, posterior fusion, combined convex side epiphysiodesis, and convex side posterior fusion, convex side tether, costodesis, and concave side rib head excision have all been tried. Of these, combined anterior and posterior fusion of the convexity is the most effective, particularly for congenital hemivertebrae without rotation.