title: Serial casting as a delay tactic in the treatment of moderate-to-severe early-onset scoliosis.
abstract: BACKGROUND
  Serial casting can cure mild infantile idiopathic scoliosis. Its use in delaying surgery in older children and those with larger curves or syndromes is poorly defined.
  
  
  METHODS
  A review of a single center's experience with casting was performed. Patients were included if they had a syndromic, neuromuscular, or congenital scoliosis or were older than 2.5 years with an idiopathic scoliosis measuring >50 degrees.
  
  
  RESULTS
  A retrospective review was performed on 29 patients meeting all inclusion criteria. Of these, 12 were idiopathic and 17 were nonidiopathic curves. Average age at first cast was 4.4 ± 2.1 years, and 3.0 ± 1.8 cast changes were performed over 1.4 ± 1.1 years. Patients were transitioned to a brace and followed up for 5.5 years (range, 2.2 to 11.4 y). The main thoracic Cobb angle before casting was 68.8 ± 12.3 degrees, which corrected to 39.1 ± 16.4 degrees in a cast. Cobb angle after cast removal was 60.9 ± 18.4 degrees, which increased to 76.3 ± 24.0 degrees at final follow-up. T1-T12 height increased to 1.1 ± 2.6 cm during the treatment period (P=0.05). There were 5 minor complications. Fifteen patients (51.7%) required surgical treatment for their scoliosis at most recent follow-up and an additional 7 patients (24.1%) were delayed until a definitive anterior/posterior spinal fusion could be performed. Surgery was delayed 39 ± 25 months from the first cast. Growing rods were required in 8 patients (27.6%). The patients who ultimately underwent surgical intervention (SG) were more likely to have a larger postcasting residual main thoracic Cobb angle than those who did not require surgery [NS; 69.5 ± 14.6 degrees (SG) vs. 51.6 ± 17.9 degrees (NS), P=0.007] and had a greater progression of their curves after cast removal [20.9 ± 13.5 degrees (SG) vs. 9.4 ± 11.0 degrees (NS), P=0.02].
  
  
  CONCLUSIONS
  Serial casting is a viable alternative to surgical growth sparing techniques in moderate-to-severe early-onset scoliosis and may help delay eventual surgical intervention. Although a cure cannot be expected, an average of 39 months of delay was achieved in this patient cohort and 72.4% have avoided growing spine surgery.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Emory Orthopaedics Spine Center, Atlanta, GA 30329, USA. nicholas.d.fletcher@emory.edu
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Fletcher
authors.forename: Anna
authors.initials: A
authors.lastname: McClung
authors.forename: Karl E
authors.initials: KE
authors.lastname: Rathjen
authors.forename: Jaime R
authors.initials: JR
authors.lastname: Denning
authors.forename: Richard
authors.initials: R
authors.lastname: Browne
authors.forename: Charles E
authors.initials: CE
authors.lastname: Johnston
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae; D013997:Time Factors