The treatment for structural scoliosis at the Massachusetts General Hospital is a combination of the exercise and corrective plaster jacket methods. We have been led to this because our experience has shown us that these methods used singly have been inefficient. Together, however, they act synergetically, as it were, supplying the complementary parts lacking in each other. Together they render the method of treatment more effective, with the same amount of force, than any form of lateral bending alone in plaster casts.
The pelvis and the thorax are rotated on each other so as to warp the trunk over to the side of the concave deformity. Then the force from the resulting peripheral stresses, augmented first by the respiratory forces cultivated beforehand by intensive exercise and second by direct pressure on the posterior convexity of the ribs, is relied on for correction of the deformity.
All this seems the natural thing to do in order to straighten a twisted spine. Untwist both ends of the spine in opposite directions while separating these ends, and then force at the center. Then with the breathing in The fenestrated plaster casts the deformed parts, in following the line of least resistance, will advance through the windows to correction.
The method seems to be warranted because it is safe, ambulatory, and causes very little discomfort to the patient. It also separates very effectively the shoulder and pelvis on the concave side of the deformity. But because of the uniformity of the strain from the rotation method the deformation of the thorax, especially on the side made shorter, is much less than with any method which flexes the trunk laterally.
The brace is used to retain any correction obtained while the patient was in the corrective plaster jacket; and since with it, forces can be applied in diagonal directions, the tendency to warp the trunk towards a corrected symmetry, begun in the casts, is usually continued even in the brace.
There has been a great swing of the pendulum toward the operative treatment of structural scoliosis. It is, therefore, timely to show some results of the conservative treatment and to stress the advantages of the method. The procedure throughout is inexpensive, simple, safe, ambulatory, and without discomfort or marked atrophy. It furnishes every opportunity for a more undisturbed growth of the spine, and it leaves the patient at the end of the treatment with better body mechanics and therefore in a better state of nutrition and general health.
(C) 1924 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.