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[New approaches to the surgical treatment of severe thoracic cage diseases with respiratory repercussions].

Scoliosis is defined as lateral curvature of the spine with vertebral rotation, meaning that it is a 3dimensional deformity. Scoliosis leads to thoracic deformity if the spinal alterations occur in that zone (Figure 1). Scoliosis is classified as either idiopathic or secondary, regardless of what part of the spine is affected. Idiopathic scoliosis is currently thought almost certainly to arise from multiple factors. The most common causes are disordered development of the central nervous system or genetically determined familial disorders. The prevalence of idiopathic scoliosis in the population at risk (individuals between 10 and 16 years of age) is approximately 2% to 3%. As the magnitude of the curve increases, the incidence decreases, and it is estimated that the percentage of patients who require surgery does not exceed 0.1%. The decision of how to treat patients with spinal deformity should be based on an understanding of the natural history of the process. Any decisions taken should have as their objective the modification of that natural history. The main factors influencing therapeutic decisions are the type and magnitude of the curve, age, skeletal maturity, and sex. The most important factors at the time of diagnosis are age and curve magnitude. Age is especially important because it is related to elasticity and on elasticity will depend the possibility of reducing the angle of curvature and the patient’s muscular response to it. Respiratory Function and Deformity