1. Successful treatment of structural scoliosis must depend upon a clear understanding of the elements of deformity, and the lessening, if not complete elimination, of all of them.
2. Uniform and regular measurement and numerical record of the elements of deformity are important as guides to continuance of treatment and as indicating elements most needing correcion.
3. A balanced use of corrective plaster-of-Paris jackets, of retention brace and of intensive exercises is essential to satisfactory results.
4. The position of the patient when the plaster jacket is applied is responsible for improving body posture and shoulder carriage; the successive paddings, for care of the spinal deviation and the rotation.
5. Essentials of a retention brace are (a) ability to hold correction attained; (b) application by the patient with reasonable accuracy; (c) extensibility and lateral compressibility to meet normal growth and progressive deformity decrease; (d) mechanical self-correction by the brace seems possible, but not yet fully attained.
6. Gymnastic exercises must be progressive, intensive and with a minimum of erect weight-bearing. They must aim to correct all of the elements of deformity, especially that of rotation. Starting positions other than standing facilitate these ends.
7. Retention of deformity correction attained must be maintained while exercise is developing natural muscular support. Artificial support may gradually give way to natural support. The paralytic scoliotic must receive a larger proportion of artificial support than will be required for those not paralyzed in the trunk muscles. Internal splinting, by operative bone-fixation, may also be necessary in severe paralytic cases.
(C) 1921 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.