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Tremendous advances continue in the surgical management of spinal deformity.

The Lenke classification is a new internationally recognized standard. It is easy to use and facilitates communication about adolescent idiopathic scoliosis. Its application facilitates selective thoracic fusions for certain patients. Epiphyseal stapling of vertebral bodies in growing children to prevent progression of developing scoliosis could be the first viable treatment alternative to bracing that has arisen in the last 70 years. These early results seem promising. Modification and standardization of this potentially powerful technique are necessary. Concern about the nickel content of the implants exists. Thoracoscopic anterior release has its advocates. Seven to eight years after its introduction, however, there are still only a limited number of accomplished violinists who can play this difficult violin. Total discectomy including the posterior anulus in front of the spinal canal is very difficult. Thoracoscopic instrumentation for adolescent idiopathic scoliosis seems also to only be performed by extraordinarily committed individuals who instrument all the levels contained in the Cobb angle of the major curve. Even in their accomplished hands, correction of the major curve is only about 50% to 60%. Single-rod breakage and nonunion occur, and healing takes months. It is still an art form. The complications in inexperienced hands, and even in experienced hands, can be formidable and even life threatening. Dual-rod, short-segment instrumentation, with total apical discectomy, provides correction of the apical levels of flexible single curve scoliosis less than 75°, over half the levels usually operated by standard posterior techniques. This open technique has been safely and predictably applied by a large group of surgeons from the developed world. Excellent correction of curves less than 75°, over 5 vertebrae and 4 discs, is routine. Rapid healing (2–3 months) provided by bone-on-bone apposition reduces the recovery time. The short-segment nature of the procedure retains better spinal mobility and function. Excellent correction of the “tilt angle” and creation of normal sagittal plane alignment should reduce late lumbar pain. The excellent fixation provided by the dual-rod implants maintains all the correction obtained in the operating room without implant failures. Dual posterior rod instrumentation without fusion and spinal lengthening have revolutionized the management of curves in babies and young children who were formerly unmanageable with braces. Although the results will only become crystal clear in several more years, the preliminary reports here are very impressive and worthy of continued application and use by a wider surgeon group than just the developers. The application of short-segment techniques and wedge osteotomy correction in neuromuscular curves is also impressive. The avoidance of the serious surgical complications—nonunion, infection and implant loosening and dislodgement—seen with long-segment fusions to the pelvis in this particularly difficult patient population is important. The maintenance of functional sitting balance, transferability, and ambulation provided by short segment reconstruction will be greeted by patients and families with enthusiasm. Correction of sagittal imbalance with pedicle subtraction osteotomy, even in the hands of a master, continues to be gratifying. Transfer lesions, however, still present problems for both the patient and surgeon even after high quality corrections. Sagittal imbalance is much easier to prevent than to treat.