Pediatric Spine Foundation

Title: Serial Casting in Neuromuscular and Syndromic Early Onset Scoliosis (EOS) Can Delay Surgery Over 2 Years

Authors: Scott LaValva, Alexander Adams, Elle MacAlpine, Purnendu Gupta, Kim Hammerberg, George H. Thompson, Peter Sturm, Sumeet Garg, Jason Anari, Paul Sponseller, John Flynn, Pediatric Spine Study Group, Patrick J. Cahill

Journal: J Pediatr Orthop

Date: September 01, 2020

Excerpt: Despite its limitations, the present study is the largest dedicated series of NIS (Non Idiopathic Scoliosis) patients evaluating the outcomes of serial body casting to date. Ultimately, our results suggest that patients with NIS may have worse outcomes with respect to curve progression and the need for subsequent surgical intervention than their idiopathic counterparts, but the significant improvements in spine growth and the delay of surgery afforded by casting are 2 important benefits that we expect will enhance the long term outcomes of these patients.

Keywords: spine, scoliosis, early onset scoliosis, non idiopathic scoliosis, neuromuscular, syndromic

Summary:

Purpose

The main goal in controlling EOS is delaying surgery while allowing spinal growth and chest wall and lung development. All of which improve life expectancy. This study reviews how well casting prevents surgery in patients with neuromuscular and syndromic EOS.

Results

  • In this study of 26 Syndromic EOS patients and 18 Neuromuscular EOS patients, casting treatment delayed surgery by an average of almost 3 years. (34.5+/- 15 months)
  • There were not any noteworthy differences between the average curve before and after casting. This includes the major curve (55 vs. 60 degrees) minor curve (31 vs. 33 degrees) or rib-vertebra angle difference (18 vs. 29 degrees).
  • Thoracic height (15.5 vs. 16.8 cm) and lumbar height (8.9 vs. 9.8cm) were notably larger at the end of casting. This means that serial casting allows for growth and development of the patient.

Discussion Points

  • Delaying surgery is important when treating EOS. This study shows that serial casting can delay surgery in patients with Neuromuscular and Syndromic EOS.
  • Other studies have shown the success of serial casting in patients with Idiopathic Scoliosis. This study shows that Non-Idiopathic Scoliosis patients can also have success from casting. These successes can be more spine growth. These patients did have less curve correction through casting than patients with Idiopathic Scoliosis.
  • In the study of 26 Syndromic EOS patients and 18 Neuromuscular patients, 16 (36%) patients had some issues in treatment, however none of the complications were very serious.