Comparison of two types of casting in early-onset scoliosis

Early-onset scoliosis (EOS) can be a progressive and debilitating condition if left untreated. Different casting techniques have fallen in and out of favor over the years for conservative management. Two types of casting, elongation-derotation-flexion (EDF) and body casting (BC) are employed at our institution. Here we compare the radiographic outcomes between these two types of casting in a cohort of patients diagnosed with EOS. Sixteen children with EOS were treated by EDF serial casting while seventeen children with the same diagnosis were treated by BC. Radiographic measurements included Cobb angle, rib-vertebral-angle difference (RVAD) and vertebral rotation (VR) by Nash-Moe method in casting (IC) or out of casting (OOC), thoracic height (TH) and width (TW). All of the patients had x-ray measurements at pre-casting OOC, 1st IC and final post-casting OOC. Casts were changed every 2-4 months. Independent two sample t-test, Wilcoxon rank-sum test, and Chi-square test were performed. There were no significant differences at the initial treatment for age, classification of EOS, OOC, RVAD, VR, kyphosis, TH, and TW between EDF and BC casting. There were no significant differences of changes for OOC, RVAD, VR, kyphosis, TH and TW from pre-casting to the final post-casting status between two casting techniques (P>0.05). However, children with EDF tended to receive 3 to 4 more castings than those with BC (7.5 vs.4 casts) (P=0.007) and achieved better outcomes in success (25% vs.20%) and improvement (50% vs.10%) (P=0.03). EDF has better outcomes with EOS improvement when there is treatment of longer duration.