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Children With Presumed Early-Onset Idiopathic Scoliosis and Treated in Cast May Have Delayed Ambulation
Oliver X Dong1, Bryan O Ren2, Peter Sturm3
1Case Western Reserve University School of Medicine.
Insights
Serial casting for early-onset idiopathic scoliosis (I-EOS) may be associated with delayed walking ability. Factors like male sex and larger initial curves correlate with later ambulation in I-EOS patients treated with casts.
Area of Science:
- Pediatric Orthopedics
- Spinal Deformities
- Developmental Pediatrics
Background:
- Serial casting is a recognized treatment for early-onset idiopathic scoliosis (I-EOS).
- The effect of serial casting on the development of walking ability in I-EOS patients has not been previously investigated.
Purpose of the Study:
- To evaluate the influence of serial casting on the age of ambulation in patients diagnosed with I-EOS.
Main Methods:
- Retrospective multicenter review of I-EOS patients treated with serial casting before 18 months of age.
- Exclusion criteria included patients already ambulatory or with incomplete records.
- Data analysis focused on ambulatory status, curve magnitudes, and casting parameters, with statistical comparisons using ANOVA.
Main Results:
- Of 114 eligible patients, 30 ambulated by 18 months, 44 between 19-24 months, and 40 after 24 months.
- Delayed ambulators (>24 months) were more likely male and had larger initial major curves (47 vs. 36 degrees).
- Patients with delayed ambulation also experienced later cast removal (34 vs. 23 months) and longer casting durations (22 vs. 10 months).
Conclusions:
- Serial casting in I-EOS patients shows an association with delayed ambulation.
- Factors such as male sex, greater initial curve severity, later cast removal, and longer casting duration are linked to delayed walking.
- Distinguishing the direct impact of casting from underlying condition differences on ambulation remains challenging.
Background:
Serial casting is a safe and effective treatment for early-onset idiopathic scoliosis (I-EOS). However, its impact on a child's ability to walk has not been previously described. This study evaluates the influence of serial casting on ambulatory age in I-EOS patients.
Methods:
A retrospective multicenter review was conducted on I-EOS patients who received their first casts before 18 months of age. Excluded were patients who were ambulatory at the first visit or had incomplete records. Data collected included sex, age at first visit and cast application, number of casts, precast/postcast coronal and kyphosis curves, age at final cast removal, total duration in cast, and age at first change in recorded ambulatory status. Patients were grouped by first recorded change in ambulatory status: ≤18 months, 19 to 24 months, and >24 months. Differences were assessed using ANOVA.
Results:
Of the 203 patients, 148 were preambulatory at first visit. One hundred fourteen patients had sufficient documentation and of these, 30 ambulated by 18 months, 44 at 19 to 24 months, and 40 after 24 months. Significant differences were found in terms of sex ( P =0.012), precast major curve ( P =0.025), precast minor curve ( P =0.011), age at cast removal ( P =0.011), and casting duration ( P =0.007). Ambulators after 24 months had larger precast major curves compared with those at 19 to 24 months (47 vs. 36 degrees, P =0.019). Ambulators after 24 months also were older at age of cast removal (34 vs. 23 mo, P =0.008) and had longer casting duration (22 vs. 10 mo, P =0.007) versus ambulators at ≤18 months. No other statistical differences were observed.
Conclusion:
In I-EOS patients treated with serial casting, delayed ambulators were more likely to be male, have greater magnitude initial major curves, a later age of cast removal, or longer total cast duration. There is an apparent association of casting with later ambulatory status; however, it is impossible to separate the impact of casting from the potential differences in underlying condition.
Level Of Evidence:
Level III-retrospective chart review.
