title: Serial elongation, derotation and flexion (EDF) casting under general anesthesia and neuromuscular blocking drugs improve outcome in patients with juvenile scoliosis: preliminary results.
abstract: OBJECTIVE
  Juvenile scoliosis (JS), among different types of spinal deformity, remains still a challenge for orthopedic surgeons. Elongation, derotation and flexion (EDF) casting technique is a custom-made thoracolumbar cast based on a three-dimensional correction concept. The primary objective of the present study was to measure changes on plain radiographs of patients with JS treated with EDF plaster technique. The second aim was to evaluate the effectiveness of the EDF plaster technique realized under general anesthesia (GA) and neuromuscular blocking drugs, i.e. curare, on the radiological curve correction.
  
  
  METHODS
  A retrospective comparative case series study was performed in which were included forty-four skeletally immature patients. Three patient groups were selected. Group 1: EDF cast applied with patients awaken and no anesthesia; Group 2: EDF cast applied under GA without neuromuscular blocking drugs; Group 3: EDF cast applied under GA with neuromuscular blocking drugs. All the patients were treated with two serial EDF casts by 2 months and a half each. All measurements were taken from the radiographic exams. Cobb's angle; RVAD and Nash and Moe grade of rotation were assessed before and after applying the cast. Thirty-four (77.3 %) patients were followed up at least 24 months after removal of last EDF cast.
  
  
  RESULTS
  Eighteen patients (3 males, 15 females) were included in Group 1, 12 (2 males, 10 females) in Group 2 and 14 (5 males, 9 females) in Group 3. Serial EDF casting was more effective at initial curve reduction and in preventing curve progression when applied under GA with neuromuscular blocking drugs, i.e. curare. RVAD and Nash and Moe score improved significantly in all groups of patients treated according to principles of EDF technique. During follow-up period, six patients required surgery in Group 1 (6/18; 33.3 %), 3 patients required surgery in Group 2 (3/12; 25 %) and 2 patients underwent surgery in Group 3 (2/14; 15 %).
  
  
  CONCLUSIONS
  Preliminary results show EDF casting is effective in controlling the curve in both frontal (Cobb's angle) and transverse plane (rib vertebral angle and apical vertebral rotation degree).
authors.affiliation: Department of Pediatric Surgery, CHU Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France. canavese_federico@yahoo.fr.
authors.forename: Federico
authors.initials: F
authors.lastname: Canavese
authors.affiliation: Department of Pediatric Surgery, CHU Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France.
authors.forename: Alexei
authors.initials: A
authors.lastname: Botnari
authors.affiliation: Faculty of Medicine, University of Montpellier, 2 Rue de l'Ecole de Médecine, 34000, Montpellier, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Dimeglio
authors.affiliation: Department of Pediatric Surgery, CHU Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Samba
authors.affiliation: Biostatistics unit, DRCI, CHU Clermont-Ferrand, 58 rue Montalambert, 63000, Clermont Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Department of Anesthesia and Reanimation, CHU Clermont-Ferrand, 58 rue Montalambert, 63000, Clermont Ferrand, France.
authors.forename: Adeline
authors.initials: A
authors.lastname: Gerst
authors.affiliation: Department of Anesthesia and Reanimation, CHU Clermont-Ferrand, 58 rue Montalambert, 63000, Clermont Ferrand, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Granier
authors.affiliation: Department of Pediatric Surgery, CHU Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Rousset
authors.affiliation: Académie Nationale de Médecine, 16 rue Bonaparte, 75006, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dubousset
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D001915:Braces; D002370:Casts, Surgical; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use*; D008297:Male; D000077590:Mivacurium; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult
chemical_list: D007546:Isoquinolines; D009466:Neuromuscular Blocking Agents; D000077590:Mivacurium
keywords: Conservative treatment; EDF casting; Juvenile scoliosis; Neuromuscular blocking drugs