The Halo, Halo-Tibial, Halo-Femoral, Halo-Pelvic (Halo-Hoop) and Halo Gravity Techniques
The halo was originally used by ENT and plastic surgeons to treat facial fractures. Drs. Nickel and Perry then used it for skeletal traction to treat paralytic scoliosis cases. Later it was used with skeletal tibial and then skeletal femoral fixation to provide counterweight to the halo. The patients were nursed in bed. In the 1960’s Dr. Ronald DeWald attached a hoop to the pelvis with iliac rods through the tables of the ilium. The rods went through the ilium and were attached to the hoop. The hoop was then attached to the halo with turnbuckles. The patient could be ambulatory and shower. Correction was by distraction. Later Prof. Arthur R. Hodgson popularized and renamed it as the Halo-Pelvic device. Later, Halo Gravity traction replaced distal fixation. Halo gravity wheelchairs and Halo gravity walkers are still used for long term correction by distraction.
Harrington Spinal Instrumentation
The first major podium presentation by Dr. Paul Harrington describing his new operation for the treatment of scoliosis was made in June 1960 at the America Orthopaedic Association meeting in Hot Springs, Virginia. Although met with skepticism by many Orthopaedic Surgeons, public recognition of the importance of Harrington’s contribution is reflected in an article published in Time Magazine a few months later. In the June 1962 volume of JBJS, Harrington published the results of his surgical technique in the first 133 patients whom he treated. In 1963, Dr. John Moe presented his validation of 66 prospectively collected patients treated by Harrington’s method with favorable results. Within the next few years Harrington’s method was acknowledged as superior to fusion without instrumentation by many of the contemporary leaders in the field of scoliosis treatment because of reduced rates of pseudarthrosis and improved early mobilization as well as lower reoperation rate. Harrington Instrumentation became the standard of care in the treatment of scoliosis and other disorders requiring spinal stabilization. The wide acceptance of Harrington’s operation paved the way for future development of methods of internal fixation of the spine.
Continuing Education Course on Scoliosis by Dr. John Moe
This course was offered by Dr. John H. Moe in the fall 1964. He showed attendees almost all of his cases. With each case he gave attendees his thinking and showed his results, whether they were good or not as good. The course took place in a typical auditorium with less than 40 attendees. On the last day of the course, Dr. David B. Levine suggested that a group should be organized to study scoliosis. Dr. Moe said that if Dr. Levine would write the constitution and bylaws, that he, Dr. Moe would get it started. This was the precursor to the formation of the Scoliosis Research Society.
June 10, 1966
First Annual Meeting of the Scoliosis Research Society
There were 37 physicians and surgeons who met in Minneapolis, MN to found the SRS. The first order of business after approval of the constitution and bylaws was nomenclature. It was decided that the society would be called the Scoliosis Research Society. A scientific paper was delivered by Dr. Robert B. Winter on congenital scoliosis. Future meeting cities were identified as Los Angeles, CA and Houston, TX.
First Natural History Study of Scoliosis
“A Long Term Follow-Up Study of Non-Treated Scoliosis” by Dr. Alf L. Nachemson was published in Acta Orthopaedica Scandinavica. This paper was the first to report on a large series of untreated scoliosis patients. The report does not have x-ray information nor does it have accurate diagnoses. It is still an influential report with regard to the mortality rate of untreated severe scoliosis due to cardiopulmonary disease.
First SRS Morbidity Report
First Morbidity report presented by Dr. G. Dean MacEwen at the 3rd SRS Annual meeting included the neurological complications in scoliosis.
In response to patients refusing use of the Milwaukee Brace and Risser Cast, a custom TLSO Wilmington Brace was developed. A removable thermoplastic device for deformities with apices at-or-below T7 (JBJS Am. 1980 Jan; 62(1): 31-6) casted in a Risser frame in corrected position was the basis for this brace made from a cast mold.
First Anterior Instrumentation
Dr. Allen F. Dwyer developed the first anterior spinal instrumentation for scoliosis correction. He developed this device based on the principle that scoliosis could be corrected by either stretching the short (concave) side of the curve or shortening the long side (convex) side of the curve. The Dwyer anterior spinal implant used titanium screws placed into each vertebral body within the curve on the lateral side of the vertebral body connected together by a titanium cable. Each screw was placed through a titanium plate on the vertebral body that prevented screw cut out. The intervertebral discs were removed to allow shortening of the convex curve and to promote fusion. A button was used at one end of the cable and each vertebral was then tensioned to the adjacent screw in a step by step process down the length of the curve thereby straightening the convex side of the scoliotic curve. Although used for thoracic curves it became best known as a device for lumbar and thoracolumbar deformities.