Serial elongation derotation flexion casting in children with infantile and juvenile scoliosis

Infantile (IS) and juvenile scoliosis (JS) are among the most challenging conditions pediatric orthopedic surgeons are facing in the present days. However, the best treatment of IS and JS is still debated and it remains controversial, at least for some aspects. Untreated early onset spinal deformities may lead to pulmonary and heart compromise. Growth friendly surgical techniques imply multiple distractions with increased risk of auto-fusion, infection and curve stiffening. Serial casting has been proven to be a valuable option to treat children with early onset scoliosis (EOS) in an attempt to delay surgery (in most cases) or to cure the disease (in few cases). More than five decades ago, Cotrel and Morel from France, introduced the Elongation-Derotation-Flexion (EDF) casting technique. EDF cast is a custom-made thoracolumbar cast that corrects the deformed spine three-dimensionally. Serial EDF casting is able to modulate spinal growth and it can-at least in some cases-prevent the progression of the spinal deformity. Today, serial EDF casting technique has become one of the accepted treatment options for the management of children with IS and JS. The main objective of this work is to describe the EDF serial casting technique for the treatment of children with IS and JS, as well as to highlight its advantages and its limits by providing a review of the most recent literature.