Early ambulation with localizer cast following posterior spinal fusion without internal fixation

One hundred fourteen patients have been treated with posterior spinal fusion with no internal fixation, followed by early ambulation in localizer casts. The group included 114 patients (104 girls and 10 boys) with an average age of 14.5 years at the time of surgery. All patients underwent preoperative Cotrel traction. Localizer casts were fitted during the first postoperative week, and ambulation was begun as soon as supine films in the cast showed acceptable correction. Six months postfusion the localizer casts were removed and replaced with underarm casts, which were maintained for an additional 4 months. We have found this treatment to be quite effective in patients with single curves, with an average curve correction of 44 degrees. Results in patients with double structural curves have been less encouraging, and it would seem that such patients are best treated with internal fixation.