Delaying Tactics: Traction, Casting, and Bracing

Abstract

Nonoperative methods to delay surgical treatment, whether growth-sparing or definitive correction and fusion, are important initial treatments for early onset deformity. One method does not preclude repeated use of the same or another nonoperative method to continue to delay operative management. Prolonged HGT to initially correct a severe curve in a very young child, followed by cast and/or brace to maintain the correction achieved, is effective in delaying surgery, realizing full well that the process may need to be repeated when the deformity recurs. The most important goal to be remembered, however, is that while the delay is being extended, the deformity – both spine and chest wall – must be controlled by the delaying tactic, so that permanent degradation of lung or chest wall function does not occur.