The very young child with scoliosis is often not a candidate for surgery and in fact may not need surgery. The Early Onset Scoliosis (EOS) Center at Children’s Hospital has state of the art non-invasive treatment techniques available for these children. The patient has a cast applied to the trunk on a specially designed table that allows us to control and correct the curves
Casting treatment consists of serial casting, which entails that the cast be changed about every 8 weeks. With each new cast application there is an attempt to gradually correct the curvature. The cast is made of fiberglass, and is applied in the operating room under general anesthesia, which means that the infant will be put to sleep through the application process. This enables the best cast to be applied while the infant is sleeping. Correction is usually achieved by around 18 months of age.
Casting treatment is followed up with bracing treatment, which is needed to maintain the correction. There are a number of braces available for treatment of infantile scoliosis and there is no consensus on which is the best. Further, there is no scientific evidence that bracing in infants alters the natural history of this condition. Except for bathing and exercise, the brace is to be worn all the time, usually for 2 to 3 years, after which time the child is weaned off the brace, provided correction of the curvature has been maintained. Occasionally, curves recur after brace removal, which necessitates reinstitution of full-time bracing treatment. If the curve progresses during bracing treatment casting may be restarted or surgery may be warranted.
Our infantile idiopathic casting program utilizes both the Amil casting frame and Noel casting frame. We follow the techniques of Dr. Mehta to utilize growth as a corrective force in the treatment of progressive infantile scoliosis. Further information about casting, including tips for care of the young child in a spinal cast, is available at www.infantilescoliosis.org.
FAQs
- Is the cast being applied using the rotational Mehta Casting Technique? Yes.
- Do you have a Mehta casting table in the OR? Yes.
- Will you be taking X-Rays before and/or after the cast application in the OR? Yes.
Xrays are obtained in the OR after the cast has been applied to see how much correction is obtained. Another xray will be taken at the follow up visit which will be about 8 weeks after the cast application. Those xrays are taken after the cast has been removed. - How is the cast removed?
It is removed with a cast saw by our orthotist. This involves a somewhat loud vibrating noise. Depending on the age you could bring child headphones to try and block the noise. - Will there be cut-outs in the back of the cast as well as the front?
There will be a cut out in the back that you will see and then a relief. At the end of the casting this gets overlayed with fiberglass so you will not see this cut out but there will be a bit of a relief in it under the fiberglass. - Is the cast over or under the shoulder?
In most cases it is under the shoulder - How long are you out of the cast in between cast applications.
It can vary based on the OR schedule but it is typically 1 week.
Resources
- Amil Frame: http://www.amilframe.com
- Noel Frame: http://www.noeledfcastframe.com
- Infantile Scoliosis Outreach Program: http://www.infantilescoliosis.org
- Infantile Scoliosis Book “Cole and the Crooked Flower”: https://youtu.be/LFcqyNG2ypc