Trends in the management of scoliosis
“WATCHFUL waiting” in regard to children with scoliosis is no longer an acceptable form of management. Prompt and effective treatment is now possible because of recent improvements in technic and in devices. Five of these important advances are: the localizer cast,1, 2 the Milwaukee brace,3 the halo apparatus,4 Harrington instruments and devices,5 and the massive autogenous iliac bone graft for spinal fusion.6 The greatest challenge now facing the orthopedic surgeon is in clarifying the etiology of idiopathic scoliosis.7
The localizer cast developed in 19521, 2 offers important advantages in comparison with its predecessor the turn-buckle cast: earlier postoperative ambulation of the patient, less time-consuming and less difficult application. The localizer cast is applied on a special frame and requires a minimal amount of padding. A distraction force is applied by means of traction on the chin and pelvis. This force helps to correct the spinal curvature. Posterolateral forces are then directed by means of pushers into the apex of the curves, and help to correct the rotary deformity of the spine as well as the lateral curvature. A well-molded pelvic plaster cast is applied, and a thoracic, neck, and chin plaster piece is constructed to fit beneath the mandible and under the occiput. Large windows, including a cardiac and abdominal window, are fashioned over the anterior cast (Fig. 1A and B). A large posterior window is created over the fusion area and the iliac crest. Knowledge of the correct application of this type of body cast is basic . . .