Serial casting in early onset scoliosis: syndromic scoliosis is no contraindication

Abstract

BackgroundSerial casting is a treatment for early onset scoliosis (EOS) in young children to achieve curve correction before bracing or to postpone initial surgical treatment until the patient is older. Good results have been reported for patients with idiopathic early onset scoliosis (IS). However, there are few reports of results in non-idiopathic cases, and the benefits of non-surgical methods in the syndromic-associated early onset scoliosis subgroup are unknown.MethodsRetrospective single-institution study of patient charts and X-rays of all cases of sustained serial casting for EOS.Staged correction was obtained by applying three consecutive casts under general anaesthesia. These were changed every 4 weeks, followed by the implementation of a custom-made full-time Chêneau brace. Correction was measured by Cobb angle (CA) and rib-vertebra angle difference (RVAD) on whole spine anterior-posterior radiographs. Statistical analysis was performed via ANOVA.ResultsThe study group consisted of 6 patiens with IS and 10 with non-idiopathic scoliosis (NIS) – exclusively syndromic-associated. The mean age at onset of treatment was 35 months (±15). The mean follow up was 21 months (±15). In IS patients average CA/RVAD before treatment was 46°(±8)/20°(±12). In NIS patients average CA/RVAD before treatment was 55°(±15)/24°(±14). After application of the third cast, the CA/RVAD was reduced to 20°(±11)/11°(±10) in IS patients. Whereas in NIS patients average CA/RVAD after the thrid cast was 28°(±12)/18°(±13). At latest follow-up the CA/RVAD was 16°(±7)/9°(±8) in IS patients and 31°(±11)/17° (±15) in NIS patients.ConclusionSyndromic etiology is not a contraindication for serial casting in EOS. Our results show a curve correction, measured in CA, of 65% in IS patients and 44% in NIS patients. Significant reduction in the morphologic deformity, measured in RVAD, was achieved in the IS cohort, but not in the NIS cohort. In all cases surgical treatment could be delayed.

Clinical Results of Corrective Cast and Brace Treatment for Early-onset Scoliosis: The Effectiveness of Long-term Cast Treatment That Extends into Children’s Schooldays

“…Although cast application for older patients with larger curves or a nonidiopathic etiology still results in curve improvement, it is also a valuable option to delay surgical treatment, even in patients with a nonidiopathic etiology. 7,8,[12][13][14][15][16][17][18][19] Moreover, this treatment is considered safe because few complications occur in spite of the decreased chest wall compliance and restricted pulmonary function, [18][19][20][21][22] and delaying surgery helps to decrease numerous complications of growth-friendly procedures. 12,23 Although various types of cast treatment cannot achieve better curve correction than growing rod surgery, the results of cast application are generally satisfactory and may serve as one treatment option for EOS.…”

Association of tidal volume during mechanical ventilation with postoperative pulmonary complications in pediatric patients undergoing major scoliosis surgery

“…The association between TV and subsequent complications cannot be construed as causal yet, and the precise causal mechanisms cannot be inferred from this analysis. Furthermore, The number of patients under 3 years of age who underwent major spinal surgery was relatively low, partly because of the low proportion of infantile scoliosis (only 1% in idiopathic scoliosis patients) 17 and the use of serial cast and brace to delay the first operation by controlling the curve progression for some children under 3 years old 25 . It should be taken into account when interpreting and applying the results.…”

“…of serial cast and brace to delay the first operation by controlling the curve progression for some children under 3 years old 25. It should be taken into account when interpreting and applying the results.…”

The Evolution of EDF Casting

“…24 Ballhause et al had similar results in the syndromic scoliosis population with a 44% decrease in curve magnitude after serial cast treatment. 25 Ultimately, there continues to be significant variability in the cure rates between different patients and centers. Numerous predictors of success have been delineated including younger age at initiation of treatment 10,19 as well as correction in the initial cast, 15,17,19 and lastly, curve magnitude at cessation of casting.…”