Serial casting as a delay tactic in the treatment of moderate-to-severe early-onset scoliosis

Nicholas D. Fletcher, Anna McClung, Karl E. Rathjen, Jaime R. Denning, Richard Browne, Charles E. Johnston

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

BACKGROUND: Serial casting can cure mild infantile idiopathic scoliosis. Its use in delaying surgery in older children and those with larger curves or syndromes is poorly defined. METHODS: A review of a single center's experience with casting was performed. Patients were included if they had a syndromic, neuromuscular, or congenital scoliosis or were older than 2.5 years with an idiopathic scoliosis measuring >50 degrees. RESULTS: A retrospective review was performed on 29 patients meeting all inclusion criteria. Of these, 12 were idiopathic and 17 were nonidiopathic curves. Average age at first cast was 4.4±2.1 years, and 3.0±1.8 cast changes were performed over 1.4±1.1 years. Patients were transitioned to a brace and followed up for 5.5 years (range, 2.2 to 11.4 y). The main thoracic Cobb angle before casting was 68.8±12.3 degrees, which corrected to 39.1±16.4 degrees in a cast. Cobb angle after cast removal was 60.9±18.4 degrees, which increased to 76.3±24.0 degrees at final follow-up. T1-T12 height increased to 1.1±2.6 cm during the treatment period (P=0.05). There were 5 minor complications. Fifteen patients (51.7%) required surgical treatment for their scoliosis at most recent follow-up and an additional 7 patients (24.1%) were delayed until a definitive anterior/posterior spinal fusion could be performed. Surgery was delayed 39±25 months from the first cast. Growing rods were required in 8 patients (27.6%). The patients who ultimately underwent surgical intervention (SG) were more likely to have a larger postcasting residual main thoracic Cobb angle than those who did not require surgery [NS; 69.5±14.6 degrees (SG) vs. 51.6±17.9 degrees (NS), P=0.007] and had a greater progression of their curves after cast removal [20.9±13.5 degrees (SG) vs. 9.4±11.0 degrees (NS), P=0.02]. CONCLUSIONS: Serial casting is a viable alternative to surgical growth sparing techniques in moderate-to-severe early-onset scoliosis and may help delay eventual surgical intervention. Although a cure cannot be expected, an average of 39 months of delay was achieved in this patient cohort and 72.4% have avoided growing spine surgery. LEVEL OF EVIDENCE: Level IV, case series.

Original languageEnglish (US)
Pages (from-to)664-671
Number of pages8
JournalJournal of Pediatric Orthopaedics
Volume32
Issue number7
DOIs
StatePublished - Oct 2012

Fingerprint

Scoliosis
Therapeutics
Thorax
Spinal Fusion
Braces
Spine
Growth

Keywords

  • casting
  • early-onset scoliosis
  • growing rods
  • Mehta
  • scoliosis
  • VEPTR

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Serial casting as a delay tactic in the treatment of moderate-to-severe early-onset scoliosis. / Fletcher, Nicholas D.; McClung, Anna; Rathjen, Karl E.; Denning, Jaime R.; Browne, Richard; Johnston, Charles E.

In: Journal of Pediatric Orthopaedics, Vol. 32, No. 7, 10.2012, p. 664-671.

Research output: Contribution to journalArticle

Fletcher, Nicholas D. ; McClung, Anna ; Rathjen, Karl E. ; Denning, Jaime R. ; Browne, Richard ; Johnston, Charles E. / Serial casting as a delay tactic in the treatment of moderate-to-severe early-onset scoliosis. In: Journal of Pediatric Orthopaedics. 2012 ; Vol. 32, No. 7. pp. 664-671.
@article{6ad97af7834540429fb9c6ef023e01ae,
title = "Serial casting as a delay tactic in the treatment of moderate-to-severe early-onset scoliosis",
abstract = "BACKGROUND: Serial casting can cure mild infantile idiopathic scoliosis. Its use in delaying surgery in older children and those with larger curves or syndromes is poorly defined. METHODS: A review of a single center's experience with casting was performed. Patients were included if they had a syndromic, neuromuscular, or congenital scoliosis or were older than 2.5 years with an idiopathic scoliosis measuring >50 degrees. RESULTS: A retrospective review was performed on 29 patients meeting all inclusion criteria. Of these, 12 were idiopathic and 17 were nonidiopathic curves. Average age at first cast was 4.4±2.1 years, and 3.0±1.8 cast changes were performed over 1.4±1.1 years. Patients were transitioned to a brace and followed up for 5.5 years (range, 2.2 to 11.4 y). The main thoracic Cobb angle before casting was 68.8±12.3 degrees, which corrected to 39.1±16.4 degrees in a cast. Cobb angle after cast removal was 60.9±18.4 degrees, which increased to 76.3±24.0 degrees at final follow-up. T1-T12 height increased to 1.1±2.6 cm during the treatment period (P=0.05). There were 5 minor complications. Fifteen patients (51.7{\%}) required surgical treatment for their scoliosis at most recent follow-up and an additional 7 patients (24.1{\%}) were delayed until a definitive anterior/posterior spinal fusion could be performed. Surgery was delayed 39±25 months from the first cast. Growing rods were required in 8 patients (27.6{\%}). The patients who ultimately underwent surgical intervention (SG) were more likely to have a larger postcasting residual main thoracic Cobb angle than those who did not require surgery [NS; 69.5±14.6 degrees (SG) vs. 51.6±17.9 degrees (NS), P=0.007] and had a greater progression of their curves after cast removal [20.9±13.5 degrees (SG) vs. 9.4±11.0 degrees (NS), P=0.02]. CONCLUSIONS: Serial casting is a viable alternative to surgical growth sparing techniques in moderate-to-severe early-onset scoliosis and may help delay eventual surgical intervention. Although a cure cannot be expected, an average of 39 months of delay was achieved in this patient cohort and 72.4{\%} have avoided growing spine surgery. LEVEL OF EVIDENCE: Level IV, case series.",
keywords = "casting, early-onset scoliosis, growing rods, Mehta, scoliosis, VEPTR",
author = "Fletcher, {Nicholas D.} and Anna McClung and Rathjen, {Karl E.} and Denning, {Jaime R.} and Richard Browne and Johnston, {Charles E.}",
year = "2012",
month = "10",
doi = "10.1097/BPO.0b013e31824bdb55",
language = "English (US)",
volume = "32",
pages = "664--671",
journal = "Journal of Pediatric Orthopaedics",
issn = "0271-6798",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Serial casting as a delay tactic in the treatment of moderate-to-severe early-onset scoliosis

AU - Fletcher, Nicholas D.

AU - McClung, Anna

AU - Rathjen, Karl E.

AU - Denning, Jaime R.

AU - Browne, Richard

AU - Johnston, Charles E.

PY - 2012/10

Y1 - 2012/10

N2 - BACKGROUND: Serial casting can cure mild infantile idiopathic scoliosis. Its use in delaying surgery in older children and those with larger curves or syndromes is poorly defined. METHODS: A review of a single center's experience with casting was performed. Patients were included if they had a syndromic, neuromuscular, or congenital scoliosis or were older than 2.5 years with an idiopathic scoliosis measuring >50 degrees. RESULTS: A retrospective review was performed on 29 patients meeting all inclusion criteria. Of these, 12 were idiopathic and 17 were nonidiopathic curves. Average age at first cast was 4.4±2.1 years, and 3.0±1.8 cast changes were performed over 1.4±1.1 years. Patients were transitioned to a brace and followed up for 5.5 years (range, 2.2 to 11.4 y). The main thoracic Cobb angle before casting was 68.8±12.3 degrees, which corrected to 39.1±16.4 degrees in a cast. Cobb angle after cast removal was 60.9±18.4 degrees, which increased to 76.3±24.0 degrees at final follow-up. T1-T12 height increased to 1.1±2.6 cm during the treatment period (P=0.05). There were 5 minor complications. Fifteen patients (51.7%) required surgical treatment for their scoliosis at most recent follow-up and an additional 7 patients (24.1%) were delayed until a definitive anterior/posterior spinal fusion could be performed. Surgery was delayed 39±25 months from the first cast. Growing rods were required in 8 patients (27.6%). The patients who ultimately underwent surgical intervention (SG) were more likely to have a larger postcasting residual main thoracic Cobb angle than those who did not require surgery [NS; 69.5±14.6 degrees (SG) vs. 51.6±17.9 degrees (NS), P=0.007] and had a greater progression of their curves after cast removal [20.9±13.5 degrees (SG) vs. 9.4±11.0 degrees (NS), P=0.02]. CONCLUSIONS: Serial casting is a viable alternative to surgical growth sparing techniques in moderate-to-severe early-onset scoliosis and may help delay eventual surgical intervention. Although a cure cannot be expected, an average of 39 months of delay was achieved in this patient cohort and 72.4% have avoided growing spine surgery. LEVEL OF EVIDENCE: Level IV, case series.

AB - BACKGROUND: Serial casting can cure mild infantile idiopathic scoliosis. Its use in delaying surgery in older children and those with larger curves or syndromes is poorly defined. METHODS: A review of a single center's experience with casting was performed. Patients were included if they had a syndromic, neuromuscular, or congenital scoliosis or were older than 2.5 years with an idiopathic scoliosis measuring >50 degrees. RESULTS: A retrospective review was performed on 29 patients meeting all inclusion criteria. Of these, 12 were idiopathic and 17 were nonidiopathic curves. Average age at first cast was 4.4±2.1 years, and 3.0±1.8 cast changes were performed over 1.4±1.1 years. Patients were transitioned to a brace and followed up for 5.5 years (range, 2.2 to 11.4 y). The main thoracic Cobb angle before casting was 68.8±12.3 degrees, which corrected to 39.1±16.4 degrees in a cast. Cobb angle after cast removal was 60.9±18.4 degrees, which increased to 76.3±24.0 degrees at final follow-up. T1-T12 height increased to 1.1±2.6 cm during the treatment period (P=0.05). There were 5 minor complications. Fifteen patients (51.7%) required surgical treatment for their scoliosis at most recent follow-up and an additional 7 patients (24.1%) were delayed until a definitive anterior/posterior spinal fusion could be performed. Surgery was delayed 39±25 months from the first cast. Growing rods were required in 8 patients (27.6%). The patients who ultimately underwent surgical intervention (SG) were more likely to have a larger postcasting residual main thoracic Cobb angle than those who did not require surgery [NS; 69.5±14.6 degrees (SG) vs. 51.6±17.9 degrees (NS), P=0.007] and had a greater progression of their curves after cast removal [20.9±13.5 degrees (SG) vs. 9.4±11.0 degrees (NS), P=0.02]. CONCLUSIONS: Serial casting is a viable alternative to surgical growth sparing techniques in moderate-to-severe early-onset scoliosis and may help delay eventual surgical intervention. Although a cure cannot be expected, an average of 39 months of delay was achieved in this patient cohort and 72.4% have avoided growing spine surgery. LEVEL OF EVIDENCE: Level IV, case series.

KW - casting

KW - early-onset scoliosis

KW - growing rods

KW - Mehta

KW - scoliosis

KW - VEPTR

UR - http://www.scopus.com/inward/record.url?scp=84866250805&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866250805&partnerID=8YFLogxK

U2 - 10.1097/BPO.0b013e31824bdb55

DO - 10.1097/BPO.0b013e31824bdb55

M3 - Article

VL - 32

SP - 664

EP - 671

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

IS - 7

ER -