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Title: Initial Cast Correction as a Predictor of Treatment Outcome for Infantile Idiopathic Scoliosis

Authors: Jaime A. Gomez MD,1 Alexandra M. Grzywna BA,2 Patricia E. Miller MS,2 Lawrence I. Karlin MD,2 Sumeet Garg MD,3 James O. Sanders MD,4 Peter F. Sturm MD MBA, 5 Paul D. Sponseller MD,6 Jacques L. D'Astous MD,7 Michael P. Glotzbecker MD,2 Children's Spine Study Group,8 Growing Spine Study Group9

Journal: J PediatrOrthop. 37(8)

Date: December 01, 2017

Excerpt: - Patients in the unresolved group, curves greater than 15 degrees, regressed by an average of 45% from initial casting to last follow-up

Keywords: scoliosis, infant, spine, ribs, methacasts, EDF Casts; treatment outcome, early onset scoliosis, elongation derotation flexion, Mehta, casting.


What is the purpose of this study?

Early onset scoliosis (EOS) treatment options aim to control spine curvatureand allow the the chest wall and lungs to develop. Casting is now recognized a important method to harness a young patients growth and straigten the curves in the spine through growth. However, children with idiopathic infantile scolosis respond differently. It is difficult topredict if casting will resolve spinal curves or to what degree of success. This study was conducted to see if the initial in-cast curve correction could be an indicator to success. Success being defined as curve(s) measuring less than 15 degrees at last follow-up.


All 68 participants in the study were classified as idiopathic, had major curves that measured between 32 degrees and 60 degrees at initial cast application, the average being 46 degrees. The average age of initial casting was 1.8 years old and ranged from six months old to 5.9 years old. Cast treatment lasted an average of 17 months with an average of 6 cast applications. The average follow-up after cast treatment was 2.5 years. All participants moved to a brace after casting.

  • Curves improved an average of 46 degrees pre-cast to 23 degrees in the first cast
  • Younger age at initial casting, smaller curves, and greater percent correction with initial casting were associated with lower curves at last follow-up.
  • For each additional year of age at the time of initial casting curves were on average of 4 degrees greater at last follow-up.
  • For every 10% of additional correction achieved in initial cast curves were 2 degrees or less at last follow-up.
  • 37% of patients achieved casting success where curves reached 15 degrees or less.
  • Patients whose curves were 15 degrees of less also had fewer casts and shorter treatment spans.
  • Patients in the unresolved group, curves greater than 15 degrees, regressed by an average of 45% from initial casting to last follow-up

Discussion Points

Patients in this study had the best outcomes when casting started at a younger age and with smaller curves. This indicates early casting treatment is critical to success. Delaying casting treatment may negatively affect outcomes. Some patients in the study were treated with a brace before casting; this suggests casting may be the best first treatment option. This study confirms that higher initial in-cast correction is a good indicator to success.

This study did not differentiate what factors might lead to greater in-cast correction or cast quality, though all casts were applied in the EDF style. It's important to note there is likely a learning curve related to quality casts and improved technique can obtain larger in-cast correction and better outcomes.

It's also important to note that unresolved curves that are greater than 15 degrees are not necessarily failures, if the curve does not progress with bracing and does not require surgery. In addition, many patients know getting a curve under 15 degrees through casting alone in unlikely but understand delaying surgery can be a benefit.