Scott Luhmann, MD, the author of this blog, is a pediatric orthopedic surgeon at Washington University Orthopedics in St. Louis specializing in pediatric and adolescent spine surgery. He practices at St. Louis Children’s Hospital and Shriners Hospitals for Children in St. Louis, Missouri. Your comments and feedback are encouraged.
Thursday, October 6, 2016
Casting of Early-Onset Scoliosis
casting is a time-tested intervention which was first described, in modern
literature, by Cotrel and Morel in 1964.At that time there were no other effective means to correct spinal
deformities and maintain the improvement, since spine instrumentation as we now
know it was not yet created. In 1963 Dr. Harrington developed the first
effective, posteriorly-based spine instrumentation, using mainly two points of
fixation on the spine and distraction as it main treatment force.It was common to supplement fusions
postoperatively with casts and braces for an extended period of time
(years).The technique of spine casting
was advanced by Risser in 1976 with the utilization of a three-point molding
technique.It was around this time the
first segmental spine instrumentation was created by Cotrel and Dubousset and
made spine casting less needed for scoliosis treatment.Since that time spine instrumentation has
evolved significantly, enabling physicians to better correct the spine
three-dimensionally without a need to use spine casting.Hence casting was performed less and less for
the treatment of scoliosis until in 2005 when Min Mehta reported the use of
Cotrel spine casting technique in children younger than 2 years.Her results re-invigorated interest in spine
casting as a method to improve and, at times, definitively correct scoliosis.
two main factors that occur between 0-5 years of age, which makes spine casting
effective is the rapid growth of the spine and the child’s spine
flexibility.So castings will be more
effective if the child is less than 18 years of age, with a highly flexible
deformity which is mild to moderate in magnitude.It is in this age group spine casts have the
greatest chance of permanently “curing” the scoliosis.In the older children, say 2-5 years, casting
can be helpful but will only be a “cure” if the scoliosis is very mild.Even if the casting doesn’t “cure” the
scoliosis it may delay the need for surgical correction.
spine casting is deemed appropriate for a child’s scoliosis, the number of
casts and the length of application is individual specific.No two children are treated exactly the same,
since no two scoliosis deformities are the same.Each doctor who using spine casting is attempting
to correct the child's spine deformity optimally with the minimum number of
anesthetics and surgical procedures.Hopefully the child will never need a surgical intervention.
last point: it is important not to get pre-occupied with the “name” of the
spine casting the surgeon is recommending.Parents have, on occasion, come to think that only Mehta casting works
and that a cast by any other name does not.Sometimes the casts are referred to as Risser casts, but any surgeon who
cares for early-onset scoliosis in 2016 will do the technique which is
attributed to Mehta.As mentioned
earlier the actual technique was described by Cotrel and Morel in 1964 and can
be called by many names: derotation casting, Cotrel casting, Cotrel derotation
casting, Extension-derotation casting, etc…….What is most important is the surgeon focuses the corrective maneuvers
of casting to unspin the spine’s abnormal twist with scoliosis.
Y, Morel G.The elongation-derotation-flexion
technic in the correction of scoliosis.Rev Chir Orthop Reparatrice Appar Mot 194;50:59-75.
JL, Sanders JO.Casting and traction
treatment methods for scoliosis.Orthop
Clin N Am 2007;38:477-84.
MH.Growth as a corrective force in the
early treatment of progressive infantile scoliosis.J Bone Joint Surg [Br] 2005;87:1237-47.
JC.Scoliosis treated by cast correction
and spine fusion.Clin Orthop Relat Res