Casting May Be the Future of Treating Progressive Infantile Scoliosis

A new study claims that serial cast correction using the Cotrel derotation technique could play a role in the treatment of Progressive Infantile Scoliosis (PIS), with cures in young patients and reductions in curve size with a delay in surgery in older patients.

Researchers at the University of Rochester Medical Center (URMC, New York, USA) followed 55 patients with PIS at three Shriners Hospitals for Children, located in Erie (PA), Salt Lake City (UT), and Chicago (IL). Data, including etiology, Cobb angles, rib vertebral angle difference, Moe-Nash rotation, and space available for the lung were recorded over time. The diagnosis of progressive scoliosis was made based upon either a progressive Cobb angle or a rib vertebral angle difference of more than 20 degrees at presentation. Pediatric orthopedic specialists used a method of casting called EDF (extension, derotation, and flexion) that capitalizes on children's rapid growth to untwist and uncurve their spines over time. The method uses a specialized table and casts with strategically placed holes.

The researchers found that at than one year of follow-up from the initiation of casting, all but six patients responded to cast correction. Nine patients have undergone surgery to date, six because of worsening and three by parental choice. Initiation of cast correction at a younger age, moderate curve size (less than 60 degrees), and an idiopathic diagnosis were found to carry a better prognosis than an older age of initiation, curve of over 60 degrees, and a nonidiopathic diagnosis. The space available for the lung improved from 0.89 to 0.93, and no patient experienced worsening of rib deformities. The study was published in the October 2009 issue of the Journal of Pediatric Orthopedics.

"We can cure some children with progressive infantile scoliosis, something we can't do with surgery and devices,” said lead author James Sanders, M.D., chief of pediatric orthopedics at the URMC. "If we cast these children before their curvatures become severe and before they turn two, our chances of avoiding surgery and potentially curing them are much better.”

Children are given anesthesia and ventilated during the casting because the pressure on the chest during the procedure can make breathing difficult. The cast may extend over the shoulders like a tank top and down to the pelvis, but large holes are left open between to relieve pressure on the chest and abdomen while preventing the ribs from rotating. The entire procedure can take less than an hour. Depending on the child's age and severity of the curvature, the series of casts (removed and refitted every eight to 12 weeks) could be completed in about two years.

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