Pediatric Spine Foundation

Title: A report of two conservative approaches to early onset scoliosis: serial casting and bracing

Authors: Ying Li, Jennylee Swallow, Joel Gagnier, George H. Thompson, Peter F. Sturm, John B. Means, Paul D. Sponseller, Michael P. Glotzbecker, Pediatric Spine Study Group

Journal: Spine Deformity

Date: September 28, 2022

Excerpt: Previous reports have demonstrated the effectiveness of casting for EOS. Brace treatment for EOS has not been studied. The purpose of this multicenter retrospective study was to compare radiographic outcomes, complications, and instances where surgery was necessary following casting or bracing in children with EOS treated with casting or bracing.

Keywords: Early onset scoliosis, Treatment, Nonoperative, Casting, Bracing

Summary:

Purpose

This is the first study to evaluate outcomes of serial casting compared to bracing for the treatment of idiopathic and neuromuscular EOS (early-onset scoliosis). Nonsurgical treatment methods for EOS such as casting and bracing are preferred, as early thoracic fusion can result in pulmonary issues, and growth-friendly techniques are associated with high complication rates.

Results

  • Sixty-eight patients (36 cast, 32 brace) were included in this retrospective study. The cast and brace patients had similar complications, including skin abrasions and cast removals due to soiling, and conversions to surgery.
  • Analysis showed that the treatment method was associated with a difference in T1–T12 length. While thoracic length increased in both groups, the brace patients had a greater annual increase in T1–T12 length compared to the cast patients.
  • Treatment method was also associated with difference in major curve magnitude. Although the cast patients had a significantly larger major curve at start of treatment (50° vs 31°), both groups had a similar maximum spine curvature at most recent follow-up (36° vs 32°), suggesting that casting resulted in curve improvement while bracing only maintained the curve.

Discussion Points

  • The study found that casting may lead to curve improvement in patients over age 2 years with idiopathic and non-idiopathic EOS. In comparison, brace treatment appeared to prevent curve progression in patients with idiopathic EOS but did not appear to control the curve in neuromuscular EOS.
  • The goals of treatment of EOS are to control spinal and chest wall deformity while optimizing pulmonary function and maximizing growth and motion of the spine with a low complication rate. Overall, this study provides evidence on the effectiveness of serial casting and bracing as nonsurgical treatment options for early-onset scoliosis, with casting leading to curve improvement and bracing preventing curve progression in patients with idiopathic EOS.