Pediatric Spine Foundation

Title: Awake serial body casting for the management of infantile idiopathic scoliosis: is general anesthesia necessary?

Authors: Scott LaValva, Elle McAlpine, Noriaki Kawakami, Jigar Gandhi, Kazuahi Morishita, Peter Sturm, Sumeet Garg, Michael Glotzbecker, Jason Anari, John Flynn, Pediatric Spine Study Group, Patrick Cahill

Journal: Spine Deformity

Date: May 07, 2020

Excerpt: Patients who underwent awake casting had similar radiographic outcomes as compared to those who were under general anesthesia during the procedures. Thus, awake casting may provide a safe and effective alternative to the use of general anesthesia in patients with infantile idiopathic scoliosis.

Keywords: Early-onset scoliosis, Infantile Idiopathic scoliosis, Mehta casting, General anesthesia

Summary:

Purpose

Serial body casting for infantile idiopathic scoliosis (IIS) is usually performed under general anesthesia. However, general anesthesia (GA) has been reported to have dangerous, neurotoxic properties in young children. Entertainment with devices such as tablets has been suggested as an alternative to anesthesia during serial body casting. This study aims to compare the radiographic and clinical outcomes of serial body casting for infantile idiopathic scoliosis (IIS) with and without the use of general anesthesia.

Results

  • Of the 121 patients included in this study, 92 underwent casting procedures with the use of general anesthesia ("asleep") and 29 were entertained with electronic devices without the use of general anesthesia ("awake" group).
  • After first cast application, patients in the "awake" group experienced a greater correction of spine curvature (58% vs 52%) and greater improvement in thoracic spine height (27% vs. 13%) compared to patients treated with general anesthesia ("asleep").
  • The total duration of casting was significantly longer in the "awake" group as compared to the asleep group (3.4 vs. 2.4 years). There was a greater absolute thoracolumbar spine height in the awake group (29.3 vs. 26.1 cm), in addition to a greater percent improvement from baseline (50% vs. 9%). The rate of casting success was also significantly higher in the awake group as compared to the asleep group (72% vs. 48%)

Discussion Points

  • There were significant differences between the "awake" and "asleep" groups, as the "awake" patients were older and had more severe curve magnitudes. To account for these differences, pre- and post-casting changes are analyzed as percentages.
  • One limitation of this study is that the casting method used in the patients treated with general anesthesia is different from the casting method used in the "awake" patient group. However, the first in-cast curve correction measurements were not affected by the differences in casting method and demonstrated that the "awake" group had greater curve correction.
  • Serial casting was effective in preventing deformity progression and delaying surgical intervention in both asleep and awake groups. Those who underwent casting without the use of general anesthesia experienced similar, and sometimes better, radiographic results, without exposure to potentially dangerous anesthetics.