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Most severe scoliosis and kyphoscoliosis are not unfrequent in European countries. The purpose of their treatment is not only cosmetic but, often, vital. Patients are hypotrophic and their vital capacities usually very poor. Since 1952, the authors have treated (partial, reduction and fusion) 183 patients: with curves above 100 degrees (101 degrees-203 degrees). Reduction was obtained by distraction cast or halo-traction. Surgical treatment (one or two stages) used Harrington rods and fusion with a large amount of iliac bone. These procedures are dangerous for the medullary function. Controls must be performed during the operative distraction. Follow up studies demonstrated the stability of the obtained reductions.

The authors have reviewed 58 cases submitted to strut grafting in the concavity of the curve. There were 44 kyphoscolioses and 12 kyphoses. The average follow-up was more than two years and the average pre-operative deformity was 127 degrees. The average improvement was 38 degrees and the secondary loss was only 3 degrees. The results are analysed with regard to the surgical technique used. In some cases, posterior fixation was added and the graft was either from the tibia, the fibula or a rib. In 16 cases a secondary fracture of the graft was found. It appeared between the fourth and tenth post-operative months. During this period, reduction of the graft was seen. The graft was found to thicken later at about the eighteenth post-operative month. It is concluded that the technique is worthwhile provided it is associated with posterior internal fixation, and that an external brace is worn for at least eighteen months after operation.

The authors describe three cases of megspondylodysplasia, an original syndrome first described in 1972. This congenital lesion is associated with severe kyphoscoliosis, multiple hemimelic enchondromatoses of the spine, hands, feet, knees and hips and hypertrophy of half of the body. In the discussion, differentiation between this syndrome and other diseases such as Ollier's or Mafucci's disease is described. Surgical correction on such a severely deformed spine is dangerous to the spinal cord.

Scoliosis is a complication of spinal lesions in neurofibromatosis, and leads frequently to major deformities with dislocations. The authors conducted a critical study of 31 cases surgically treated during the 1954-73 period of time. The techniques of spine straightening and of arthrodesis were recalled. The authors conclude that in case of moderate deformity (less than 100 degrees) Harrington's operation was satisfactory enough when correctly conducted. In case of severe dislocation and kyphosis, straightening was obtained after long lasting casts and halo tractions. Then posterior fusion using Harrington's rods had usually to be completed by anterior, transthoracic fusion for better solidity.