Three Solutions to a Single Problem

Halanski, Matthew A.; Harper, Benjamin L.; Cassidy, Jeffry A.; Crawford, Haemish

doi:10.1097/bsd.0b013e3182440dce

Cited by 7 publications

(3 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the Mehta protocol is well established, there are some institutions that have opted for non-Mehta tables including Traction Frames, Spica tables, Risser, and OSI tables due to the high costs of purchasing Mehta tables or physician preference. 17,[19][20][21] Physicians have reported successful applications of Mehta castings without using specialized tables, however, these results do not take anesthesia time into consideration. 17,19 Mehta tables are specifically designed to allow for easy access to the pa-tient's body while supporting the head and limbs.…”

Section: Discussionmentioning

confidence: 99%

“…17,[19][20][21] Physicians have reported successful applications of Mehta castings without using specialized tables, however, these results do not take anesthesia time into consideration. 17,19 Mehta tables are specifically designed to allow for easy access to the pa-tient's body while supporting the head and limbs. 22 In describing the Mehta casting technique, Sanders states that Risser and Cotrel frames can be used, but their large size is less than ideal for these procedures.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Institutional Variability in Anesthesia Time for Mehta Casting in Early-Onset Scoliosis (EOS)

Bonsignore-Opp,

Malka,

Ball

et al. 2024

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Purpose: Mehta casting is a potentially curative intervention for early-onset scoliosis (EOS) that typically requires multiple anesthetics. The Food and Drug Administration (FDA) reported that >3 hours of anesthesia under the age of 3 years old may alter brain development; however, no standard exists for the duration of anesthesia during casting. The purpose of this study is to quantify the variability in anesthesia during Mehta casting. We hypothesize that significant institutional variability exists and may be attributed to modifiable factors. Methods: An EOS registry was used to identify patients who underwent at least one Mehta casting procedure. Anesthesia exposure was quantified, and site variability was assessed by patient characteristics, cast placement, procedure type, and equipment used. Results: Our cohort consisted of 208 patients from 5 institutions (age 2.6±1.4 y). There were 1097 Mehta casting procedures, with 5.4±3.6 castings per patient. Of these patients, 106 (51%) were female, with an average age of 2.11±1.29 years old at the time casting was initiated. Patient etiologies included 154 idiopathic (74.0%), 22 syndromic (10.6%), 18 congenital (8.7%), 11 neuromuscular (5.3%), and 3 unknown (1.4%). Anesthesia time was 69±31 minutes and varied significantly between sites (59±14 to 117±46 min; P<0.001). Cumulative anesthesia time for patients under 3 years was 320±197 minutes with 120/161 (74.5%) patients exceeding 3 hours. Anesthesia time was lower after the FDA warning in 2016 compared with pre-2016 (71±30 vs. 66±32, P=0.008). Conclusions: Patients undergoing Mehta casting are at significant risk of exceeding 3 hours of anesthesia, which the FDA has stated may be harmful for children <3 years. Significant site variability indicates that standardization protocols should be developed to encourage best practices and minimize anesthetic times. Level of Evidence: Prognostic Level II.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Institutional Variability in Anesthesia Time for Mehta Casting in Early-Onset Scoliosis (EOS)

Bonsignore-Opp,

Malka,

Ball

et al. 2024

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Underlayers previously described include stockinette, 6 , 7 webril, 14 felt on bony prominences and silver impregnated shirt, 8 , 10 pads and splints, 27 or gore pantaloons. 28 The comparative ability of these methods to prevent skin ulceration or improve results remains unknown. For example, a recent study found the addition of adhesive pads increased major curve correction.…”

Section: Discussionmentioning

confidence: 99%

Survey to describe variability in early onset scoliosis cast practices

Grzywna

McClung

Sturm

et al. 2018

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

PurposeTo investigate paediatric orthopaedists’ cast practices for early onset scoliosis regarding patient selection, cast application, radiographic evaluation, treatment cessation and adjunctive bracing.MethodsA casting survey was distributed to all paediatric orthopaedists in Children’s Spine and Growing Spine Study Groups (n = 92). Questions included physician and patient characteristics, technique, treatment, outcomes, radiographic measurements and comparison to other treatments. A total of 55 orthopaedists (60%) responded, and descriptive statistics were calculated on the subset who cast (n = 45).ResultsA majority of respondents use cast treatment for idiopathic and syndromic scoliosis patients, but not for neuromuscular or congenital scoliosis patients. Major curve angle ranked most important in orthopaedists’ decision to commence cast treatment, in comparison with rib-vertebra angle difference or clinical observations. The major curve angle threshold to initiate casting was a median of 30° (20° to 70°), and the minimum patient age was median ten months (3 to 24). First in-cast and out-of-cast radiographs are taken standing, supine, awake, under anesthesia and/or in traction. In all, 58% consistently cast over or under the arm, while 44% vary position by patient. Respondents were divided about the use of a brace after cast treatment: 22% do not prescribe a brace, 31% always do and 36% do in some patients.ConclusionsFuture multicentre research studies must standardize radiographic practices and consider age and major curve angle at cast initiation and termination, scoliosis aetiology, shoulder position and treatment duration. Practices need to be aligned or compared in these areas in order to distinguish what makes for the best cast treatment possible.Level of EvidenceV, Expert opinion

show abstract