Evolution of casting techniques in early-onset and congenital scoliosis

Abstract

Casting is being utilized as a therapeutic strategy in some mild to moderate cases obviating surgical intervention for management of early-onset scoliosis (EOS). Bracing, another conservative modality, applies comparable correcting forces on chest wall and axial skeleton. But cast application carries additional advantage of sustained restorative force which bypasses issue of compliance seen with brace wear. There is no specific blanket treatment, conservative or surgical, for the early-onset spinal deformities. Serial cast application provides near total correction of less severe curves (less than 50 0 to 60 0 ) if treatment is initiated before age of 2 yrs. In this review article, we will assess the evolution of plaster cast application in management of EOS and also describe technique of EDF (Elongation-Derotation-Flexion) casting.

Tratamiento de la escoliosis neuromuscular en niños pequeños con parálisis cerebral espástica grave: revisión sistemática de la bibliografía

“…Los yesos correctores han sido útiles en ciertas ECT; 31 se indican generalmente para curvas entre 30° y 50°-60° y para pacientes <4-5 años. 13,32 Lamentablemente la información sobre pacientes con PC tratados con este método es escasa e inadecuada. 30,32 Además, y si bien el tipo y la tasa de complicaciones son bajos y de poca importancia, 32 en general, la mayoría de los que utilizan yesos como tratamiento para las ECT no lo hacen para el subtipo de la PC espástica.…”

“…13,32 Lamentablemente la información sobre pacientes con PC tratados con este método es escasa e inadecuada. 30,32 Además, y si bien el tipo y la tasa de complicaciones son bajos y de poca importancia, 32 en general, la mayoría de los que utilizan yesos como tratamiento para las ECT no lo hacen para el subtipo de la PC espástica. 33 Se cree que, en pacientes cuadripléjicos, nivel V del GMFCS, las dificultades y los riesgos de su uso superarían los beneficios; en el estudio de Lavalva y cols., 30 se muestra que se los puede indicar especialmente en niños de muy baja edad (promedio 3.2 años), según los principios de Mehta, 31 con aceptable nivel de mantenimiento de control de las curvas, hasta que se puede pasar a otro tipo de tratamiento.…”

Comparison and Evaluation of the Accuracy for Thoracic and Lumbar Pedicle Screw Fixation in Early-Onset Congenital Scoliosis Children

“…In such cases, nonsurgical treatments often yield limited therapeutic effects. Cast or brace treatment can serve as an option [6] for clinicians but typically only delays the age at which surgical intervention becomes necessary.…”

Elongation-Derotation-Flexion Casting Treatment of Early-Onset Progressive Scoliosis in Skeletal Dysplasia

“…[1][2][3][4][5] The goal of treatment is to limit the progression of scoliosis, allowing for continued growth of the spine and thoracic cavity to maximize potential longitudinal growth and lung function. 6,7 There is heightened concern in short-statured children with skeletal dysplasia, and the current literature does not adequately address progressive scoliosis in this population. In children 9 years of age or younger with infantile/juvenile idiopathic scoliosis, serial casting has been successful 8,9 ; however, this technique is not well understood in children with skeletal dysplasia.…”

“…Early-onset progressive scoliosis in children with skeletal dysplasia is known to cause irreversible cardiopulmonary restrictive disease 1–5. The goal of treatment is to limit the progression of scoliosis, allowing for continued growth of the spine and thoracic cavity to maximize potential longitudinal growth and lung function 6,7. There is heightened concern in short-statured children with skeletal dysplasia, and the current literature does not adequately address progressive scoliosis in this population.…”