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Published on: October 16, 2013
Results of Casting in Severe Curves in Infantile Scoliosis
Peter J Stasikelis1, Ashley M Carpenter
1Shriners Hospitals for Children, Greenville, SC.
Insights
Casting can delay the need for scoliosis surgery in young children with severe curves. This treatment was effective in all cases, with some experiencing curve resolution.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Medical Imaging
Background:
- Casting for infantile scoliosis is most effective for small curves in children under two.
- This study investigates casting's efficacy in delaying surgical intervention for severe scoliosis (50-106 degrees) in children up to three years old.
- The impact of comorbidities like syrinx or genetic syndromes on casting outcomes was also examined.
Purpose of the Study:
- To determine if casting can postpone the requirement for growth-friendly instrumentation in severe infantile scoliosis.
- To assess the effectiveness of casting in managing severe scoliosis curves (50-106 degrees) in children aged three years or younger.
- To evaluate the influence of comorbidities (syrinx, genetic syndromes) on treatment outcomes.
Main Methods:
- A retrospective review of 148 children treated with casting for scoliosis over eight years.
- Inclusion criteria: initial curve ≥50 degrees, age ≤3 years at casting initiation, and ≥3 years follow-up.
- Magnetic resonance imaging (MRI) was used to identify comorbidities; 44 children met the criteria, including 10 with syrinx, 10 with genetic syndromes, and 26 idiopathic cases.
Main Results:
- Curve resolution occurred in 35% (9/26) of idiopathic cases and 17% (3/18) of cases with comorbidities.
- Of those without resolution, 14 curves were maintained within 15 degrees, and 13 improved by ≥15 degrees.
- Only 5 children experienced a curve increase of ≥15 degrees; 4 of these underwent surgery after a mean delay of 71 months.
Conclusions:
- Casting effectively delayed the need for surgical instrumentation in all evaluated severe scoliosis cases.
- The study observed curve resolution in 12 out of 44 children treated with casting.
- Casting demonstrates potential as a conservative management strategy for severe infantile scoliosis, even with comorbidities.
Background:
Previous work has demonstrated best results for casting in infantile scoliosis when the curves are small and the child begins casting under 2 years of age. This study examines if casting can delay the need for growth friendly instrumentation in severe curves (50 to 106 degrees) and how the comorbidities of syrinx or genetic syndromes affected outcomes.
Methods:
All children undergoing casting for scoliosis at a single institution over an 8-year period were examined. Inclusion criteria included initial curve at first casting of ≥50 degrees, age ≤3 years at the start of casting, and a minimum follow-up of 3 years. Of 148 children undergoing casting during this period, 44 met our inclusion criteria. All children underwent magnetic resonance imaging. Ten children with a syrinx were identified. Ten children had known genetic syndromes (2 who also had a syrinx). The 26 children without these comorbidities were considered idiopathic. Curve magnitude ranged from 50 to 106 degrees.
Results:
Nine of the 26 (35%) children in the children with idiopathic curves demonstrated resolution of their curves, while only 3 of the remaining 18 (17%) did. Of the children that did not have resolution of their curves, 14 were maintained over the entire follow-up period to within 15 degrees of their initial curve and 13 were improved 15 degrees or more. Only 5 children had an increase of 15 degrees or more over the follow-up period and 4 of these have undergone growth friendly instrumentation after a mean delay from initial cast of 71 months (range, 18 to 100 mo).
Conclusion:
This study demonstrates that even in severe curves, casting was effective in delaying instrumentation in all cases, and led to curve resolution of the curves in 12 of 44 children.
Level Of Evidence:
Level III-case control study.
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