Spine Casting of Early-Onset Scoliosis

 

Spinal 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.

The 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.

If 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.   

One 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.

References:

Cotrel Y, Morel G.  The elongation-derotation-flexion technic in the correction of scoliosis.  Rev Chir Orthop Reparatrice Appar Mot 194;50:59-75.

D’Astous JL, Sanders JO.  Casting and traction treatment methods for scoliosis.  Orthop Clin N Am 2007;38:477-84.

Mehta MH.  Growth as a corrective force in the early treatment of progressive infantile scoliosis.  J Bone Joint Surg [Br] 2005;87:1237-47.

Risser JC.  Scoliosis treated by cast correction and spine fusion.  Clin Orthop Relat Res 1976;116:86-94.

 

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