title: Serial Derotational Casting in Idiopathic and Non-Idiopathic Progressive Early-Onset Scoliosis.
abstract: BACKGROUND
  Serial derotational casting has been used as a definitive treatment or as delaying strategy in progressive idiopathic (IS) and non-idiopathic (NIS) early-onset scoliosis (EOS).
  
  
  METHODS
  Retrospective chart and radiographic review of patients who underwent serial casting for progressive EOS between 2005 and 2012 at a single institution.
  
  
  RESULTS
  A total of 74 consecutive patients entered serial cast treatment. Twenty-eight were currently being casted, 30 completed cast treatment and were converted to thoracolumbosacral orthosis (TLSO), 9 were treated surgically, 6 were lost to follow-up, and 1 had no further treatment. The researchers diagnosed IS in 41 patients; 33 had NIS. At presentation the IS group had an average Cobb angle (CA) of 49° and a rib vertebral angle difference (RVAD) of 37°. The NIS group had a CA of 51° (p = .69) and RVAD of 37° (p = .94). In patients currently being casted, 19 IS patients had a decreased CA, from 47° to 27°. The 9 NIS patients had a decreased CA, from 62° to 57° (p = .0002). Cobb angle improvement was significantly better in IS (p = .0005). In the TLSO group the 17 IS patients had a decreased average CA, from 46° to 18°, after serial casting and the 13 NIS patients decreased CA from 42° to 32°. Patients with IS had better improvement in CA than the NIS group (p < .001). At last follow-up, this was reduced to 11° in the IS group and maintained at 32° in the NIS. In the IS group, 5 of 41 patients were converted to growth constructs, and 4 of 26 in the NIS group. Casting initiated before age 2 years yielded better curve correction for IS (p < .01) compared with NIS.
  
  
  CONCLUSIONS
  Progressive idiopathic scoliosis patients had better curve correction with casting than NIS patients. Casting in IS patients before age 24 months yielded better curve correction. Patients who required surgery had a higher age and Cobb angle at presentation than those who transitioned to a TLSO. The surgical group was observed for a similar duration of time and there was no significant statistical difference. Although RVAD is a predictor of progression in infantile IS, it did not show a predictive value in the response to casting of either the IS or NIS groups.
authors.affiliation: Department of Orthopedic Surgery, University of Illinois at Chicago, 1801 W Taylor Street, Chicago, IL 60612, USA.
authors.forename: Yazeed M
authors.initials: YM
authors.lastname: Gussous
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226, USA.
authors.forename: Sergey
authors.initials: S
authors.lastname: Tarima
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226, USA.
authors.forename: Shi
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Department of Orthopedic Surgery, Ohio State University, 2237 Oxford Rd, Columbus OH 43221, USA.
authors.forename: Safdar
authors.initials: S
authors.lastname: Khan
authors.affiliation: Shriners Hospitals for Children, 2211 N. Oak Park Avenue, Chicago, IL 60607, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Caudill
authors.affiliation: Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, Ohio 45229-3026, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Sturm
authors.affiliation: Shriners Hospitals for Children, 2211 N. Oak Park Avenue, Chicago, IL 60607, USA; Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA. Electronic address: khammerberg@shrinenet.org.
authors.forename: Kim W
authors.initials: KW
authors.lastname: Hammerberg
keywords: Early-onset scoliosis; Idiopathic infantile scoliosis; Scoliosis; Serial derotational casting