Scoliosis in China

Abstract

Scoliosis is a three-dimensional (3D) spinal deformity involving one or more spine curvatures with vertebral rotation. In the past 30 years, Chinese spine surgeons adopted international advanced technology and concepts, took advantage of abundant Chinese patient resources with severe deformity, and developed novel ideas and techniques, which promoted the development of the diagnosis and treatment for scoliosis. EPIDEMIOLOGICAL SURVEY OF SPINAL SCOLIOSIS As earlier as 1986, Chinese researchers conducted survey for scoliosis. Peking Union Medical College Hospital (PUMCH) screened 21,759 children aged 8–14 years in Beijing.[1] The results showed that the prevalence rate of scoliosis was 1.06%. Among all the patients, 87.5% were diagnosed as idiopathic scoliosis. Since the middle of the 1990s, lots of similar census appeared, mainly in Guangzhou, Shanghai, Beijing, and other big cities. After 2010, it began to spread the whole country, Heilongjiang, Xiamen, Foshan, Wenzhou, Wuxi, Sanya, Xi’an, Kunming, and other areas performed large sample screening studies. The incidence of scoliosis varied from 0.6% to 2.0%. In all of the patients with scoliosis, idiopathic scoliosis took up about 90%, and others included congenital scoliosis, neuromuscular scoliosis, and neurofibromatosis. These data provided a baseline condition of Chinese scoliosis patients and laid a foundation for making the corresponding health policy and treatment guideline. TREATMENT OF SCOLIOSIS Conservative treatment Conservative treatments for scoliosis in China include acupuncture, casting, and brace, which were not started until 1986. Among them, brace plays the major role in the nonsurgical treatment of scoliosis in China.[2] The main problems of brace treatment in China were as follows: (1) Most of the brace centers had lack of professional training, physician support, and practice standardization. (2) Clinical and basic researches of brace treatment were limited. (3) There are still many surgeons who underestimated the role of conservative treatment and therefore inappropriately expanded surgical indications. Standardization of surgical treatment In the late 1960s, Harrington's internal fixation was developed, and then Luque technique appeared in the 1970s. However, during this time, casting was the most common treatment of scoliosis in China, which was obviously lagged behind. After the reform and opening up policy in 1981, PUMCH introduced foreign advanced technology and surgical instruments (Harrington, Luque, and other techniques) into China and made the equipment nationalized to treat scoliosis. At that time, due to lack of technical standardization and unstable quality of domestic medical equipment, there are often inappropriate choice of surgical segments, Harrington's rod fracture, hook decoupling, etc., In 1983, PUMCH held the first Chinese spine deformity training course. Since then, the fixation techniques of scoliosis in China got gradually standardized and the hospitals that treat scoliosis developed rapidly. In the mid-1990s, PUMCH introduces the most advanced Cotrel-Dubousset (CD) 3D correction technology and concepts, which further led to considerable progress of scoliosis treatment in China. However, with the increasing use of 3D internal fixation systems, many researchers found trunk unbalance and decompensation after selective fusion. These new problems led spine surgeons to recognize the shortcomings of King's classification. In 2001, Lenke et al. set up a new classification for idiopathic scoliosis, which is more comprehensive with the selective fusion criteria. However, Lenke's classification was based on the definition of structural curve which arose many conflicts, with no clear guidelines for the treatment strategy for nonstructural curve. Therefore, PUMCH summarized the characteristics of idiopathic scoliosis cases in China, and established PUMC classification, which was published in Spine in 2005.[3] PUMC classification provided a clea