Serial Casting as a Delay Tactic in the Treatment of Moderate-to-Severe Early-onset Scoliosis

Abstract

Level IV, case series.

Comparison of Growing Rod Instrumentation Versus Serial Cast Treatment for Early-Onset Scoliosis

“…It also far exceeded the threshold magnitude (as low as 35 ) recommended by the proponents of GRI to initiate surgical treatment [7]. The casted patients in this study basically had their curve controlled, obtaining no change in their curve magnitude, while gaining spine length, a result consistent with other reports using casts as a delaying tactic for patients with curves averaging as much as 69 [5,6] or of surgical magnitude.…”

“…Two casting scenarios have evolved: one involving an attempt at effecting long-term control approaching what might be termed a cure in patients with smaller curves (mean, 32 ) and very young age (mean, 19 months) [4]; or one using casting as a delaying tactic to control a larger curve in an older child before embarking on surgical management [5,6]. By comparison, dual growing rod instrumentation (GRI) has been recommended for curves as small as 35 in infantile idiopathic scoliosis cases with ribvertebral angle difference RVAD greater than 20 and documented progression while braced [7], with expansion of this indication to other etiologies in selected cases.…”

Traditional Growing Rods Versus Magnetically Controlled Growing Rods for the Surgical Treatment of Early-Onset Scoliosis: A Case-Matched 2-Year Study

“…If left untreated, this condition places the patient at risk for further curve progression, pulmonary insufficiency, and early demise. Nonsurgical treatment such as casting can be beneficial to select patients when a temporary delay in surgical intervention is needed, but it may be less effective in patients with more severe and progressive curves [1][2][3]. Spinal fusion in skeletally immature patients may adequately correct the spinal deformity; however, early fusion is known to prevent normal spinal growth and may have deleterious effects on pulmonary development in the growing child [4,5].…”

Cardiorespiratory Effects of Derotational Casting during Anesthesia for Children with Early Onset Scoliosis

“…Irrespective of the treatment method, serial measurements of respiratory function should be made to determine the effects of the treatment. Preservation and/or improvement in pulmonary function are also goals of scoliosis treatment, in addition to spine deformity correction [23][24][25][26].…”