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**christine2** · 01-18-2007, 08:21 AM

Celia

Can serial casting help with congenital scoliosis as well?
I did not mean to cover your post can you move yours up so people see it?

Christine

**Celia** · 01-18-2007, 11:55 AM

Christine,

What do you mean cover the post?

To answer your other question....serial casting in the treatment of infantile idiopathic scoliosis has been shown in a few important studies to permanently correct the scoliosis. Congenital scoliosis is very different, there could be multiple vertebral anomalies or fused ribs. There is no way that casting could ever heal a hemivertebrae, however some doctors have used casting or bracing to stabilize the healthy vertebrae above or below a congenital anomaly with the intent to improve overall balance in the growth of the vertebrae. Casting or bracing congenital curves really depends on the doctor, some are strongly against it - others not.
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**pat** · 01-18-2007, 04:30 PM

Hi Celia, I just found out my 7 year old nephew has "emerging scoliosis," is that considered young enough to be infantile i . . s. . .? I've read your posts before on casting, and I truly don't understand casting as opposed to bracing????? Thanks! Pat

**Celia** · 01-18-2007, 10:22 PM

Oh Pat, I'm really sorry to hear about your nephew! If it's just emerging maybe he has the juvenile form and as you know, the spinecor brace is working really well for a few of us... so it's something to consider in his case. I'm also checking my 9 year old son's back on a monthly basis to make sure he doesn't develop it. The next time we go to Montreal, I'm bringing him along and have Dr. Rivard check him - his back looks really straight but I just want to make sure.

I think the reason why plastic braces are ineffective for infant children with progressive scoliosis is because these babies are going through rapid growth similar to adolescent children who are in the midst of the Peak Height Velocity period and as we all know this is a chaotic volatile phase. There are numerous studies pointing to the fact that conventional orthotic treatment or surgical intervention is ineffective in the management of infantile idiopathic scoliosis.

1: Orthop Clin North Am. 1999 Jul;30(3):331-41, vii

Infantile and juvenile scoliosis.
Dobbs MB, Weinstein SL.

Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.

The diagnosis and treatment of scoliosis in the infantile and juvenile age groups is a challenging and demanding endeavor. The diagnosis must be firmly established. Once a deformity has proven to be progressive, surgical intervention will likely be necessary because orthotic treatment is less effective in these cases. The surgeon is then faced with the dilemma of deciding on the most appropriate surgical treatment.

PMID: 10393759 [PubMed - indexed for MEDLINE]

1: Spine. 2003 Oct 15;28(20):2397-406.

Respiratory function and cosmesis at maturity in infantile-onset scoliosis.

Goldberg CJ, Gillic I, Connaughton O, Moore DP, Fogarty EE, Canny GJ, Dowling FE.

Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland. caroline.goldberg@ucd.ie

STUDY DESIGN: Retrospective review of patient records, clinical and radiographic, and patient recall for full pulmonary function studies and surface topography. OBJECTIVES: Assessment of outcome of treatment policy after age 15 during the previous 30 years to establish the efficacy of management protocols in a group that is too small and too varied for more formal assessment. BACKGROUND DATA: Spinal deformity presenting during infancy or early childhood poses a clinical problem caused by small numbers, long growth period, variable presentation and treatment methods, and, finally, the length of time that must pass before meaningful outcome results can be assessed. The aims of treatment are to preserve respiratory function and cosmetic appearance. MATERIALS AND METHODS: The records of patients with infantile onset, nonsyndromic, and noncongenital scoliosis were reviewed. Thirty two were at least age 15 years at the time of review and 21 of these agreed to attend for full pulmonary function testing (spirometry, lung volumes, gas diffusion) and surface topography, whereas two more had recent spirometry results available in their record. Treatment had been serial casting with Risser jacket, bracing, or surgery. RESULTS: Those whose scoliosis resolved or was stabilized by nonoperative means (N = 6) at an acceptable Cobb angle had normal cosmesis and pulmonary function (mean FEV1 = 98.7%, mean FVC = 96.6%). Those who were managed by casting or bracing and underwent surgery after age 10 (N = 6, mean age at surgery 12.9 y) had variable cosmesis and acceptable pulmonary function (mean FEV1 = 79%, mean FVC = 68.3%). Those whose deformity necessitated early surgery (N = 11, mean age at surgery 4.1 y) had recurrence of deformity and diminished respiratory function (mean FEV1= 41%, range 14%-72%, mean FVC = 40.8%, range 12%-67%). CONCLUSIONS: Although these are small numbers and treatment methods have changed since the beginning of the series, the results indicate that this condition is not simple to treat and for some children still has the risk for serious deformity and respiratory compromise. There is, as yet, no evidence that early surgical intervention in this group of patients with infantile scoliosis has altered their prognosis in any meaningful way.

Journal of Bone and Joint Surgery - British Volume, Orthopaedic Proceedings
Vol 86-B, Issue SUPP II, 113.
Copyright © 2004 by British Editorial Society of Bone and Joint Surgery

Leeds – 9–11 April, 2003
President – Mr John K. Webb
INFANTILE IDIOPATHIC SCOLIOSIS – RESULTS OF EARLY CONSERVATIVE INTERVENTION

P Heaton, C C Ong and J B Williamson
Department of Spinal Surgery, Royal Manchester Children's Hospital, Hospital Road, Manchester M27 4HA

Objectives: 1. To assess the results of early intervention in patients with infantile idiopathic scoliosis. 2. To determine prognostic factors

Design: Retrospective cohort study

Subjects: 16 consecutive patients with infantile idiopathic scoliosis who have completed a serial casting programme

Outcome measures: Curve progression, rib asymmetry and the occurrence of surgery

Results Of 16 patients 6 were male, 5 had plagiocephaly and there were 9 left sided curves. The size of the curve of all except one patient improved by casting – 4 curves resolved completely and a further 4 improved by more than 50%. Sex, the presence of plagiocephaly and the size of the curve did not influence outcome. Rib asymmetry was a negative prognostic sign. Early treatment was associated with a significantly better outcome. One child has had surgical treatment.

Conclusions Most children with infantile idiopathic scoliosis can be improved by serial casting.

Rib asymmetry is confirmed as a negative prognostic sign. Early treatment gives better results.

The abstracts were prepared by Mr Peter Millner. Correspondence should be addressed to Peter Millner, Consultant Spinal Surgeon, Orthopaedic Surgery, Chancellor Wing, Ward 28 Office Suite, St James' University Hospital, Beckett Street, Leeds LS9 7TF.

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**tinamorris11** · 05-14-2007, 08:29 AM

Type of Casting

Just a suggestion, but you may want to clarify what type of casting each of these offer. Risser vs Mehta can be a significant difference especially for a younger infant. We found this out the hard way by seeing Dr. Dillilot in Indianapolis and Dr. Crawford in Cincinnati only to realize they didn't do Mehta casting. There are only approx. 4 places in the US that do (Erie, SLC, Denver, Philadelphia- I think). I know the Shriners in Chicago does not, but will be trained by Dr. Mehta in June.

From the research that I have read, Risser casts are not as effective in infants and do not treat the rotation. Since there are larger and without cutouts, they are more restrictive of movement and do not allow for development of chest cavity/rib expansion as well as Mehta.

I agree that any cast is better than no cast, but if you have a small infant (under a year) with progressive curve and rotation then I would suggest going with the Mehta cast over a Risser cast or brace.

Thanks!

**Celia** · 05-14-2007, 09:18 AM

Hi Tina,

Scare tactics can be good because it can spur you to action or it can have the opposite effect and prevent you from doing anything. I've seen a lot of different casts and the casts currently being applied at Stanmore England where Miss Mehta practiced don't necessarily have chest cutouts - my daughter's casts didn't have chest cutouts and she didn't suffer rib cage compression because the casts were changed often. I witnessed one mom from California whose local doctor was willing to cast her infant six month old being told by some parents that the only place she could go for proper treatment was either Erie or SLC because the casts were more appealing etc. etc. They didn't have the "proper frame" at the time yet this mom was given this story! This particular mom waited three months and in the meantime the child's curve progressed and by the time she got her kid seen by the doctors in SLC it was too late... she's now looking at surgical alternatives. I could list many more parents who were given the same B.S. and are in the same boat!

Dr. D'Astous has written to other doctors stating that the casts he currently applies are Risser type casts! Dr. Sanders has advised parents whose children are getting great results at other centres to continue treatment there because they're doing well! Why is this????? Are we not to believe the doctors themselves ???? In the summer of 2003 when my daughter had been in casts for a year and a half and her in brace curve was down to 10 degrees, I was told to "grow a spine" and travel to SLC and see Dr. D'Astous because we weren't getting good enough results and my doctor at the time, Dr. Hedden didn't know what he was doing because the casts were not completely made of plaster and had some fibreglass in it. This was coming from a mom whose child's curve had already progressed to 90 degrees!!!! Needless to say this caused me a lot of stress because I started questioning the kind of treatment my daughter was getting and I started feeling like a bad mom! What's ironic about this story is that I contacted this particular mom a year before to tell her of the wonderful results we were getting with serial casting at Sick Kids and was hopeful that her daughter could be helped by the information!

You have to be very careful whose advice you listen to because if you're not, your kid could end up in the same predicament. What corrects the deformity is growth hence the title of Dr. Mehta's article "Growth as a Corrective Force"

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**tinamorris11** · 05-14-2007, 08:19 PM

Thanks Celia,
I in no way meant to imply that the Mehta casts were the only option. It is so hard to determine the right treatment for your child with different docs telling you conflicting treatment strategies and theories. The stories of parents that made a choice and then their child's condition worsened or was put in a life threatening situation (lung and heart problems, etc.) make it even harder to know what to do or what information to believe. Obviously, your daughter has had amazing success with her casting and I am so thankful for that. Dr. Crawford told us that his style of cast (Risser) does not allow for enough chest/rib expansion for someone as small as Sophia and we should try to postpone casting for as long as possible, so that was what I was going on- in addition to information from other parents in the Yahoo group. I realize that each case is different and may respond differently to various treatment options. He wants to wait one month then put her is a Risser cast June 20th since her curve is progressing pretty quick (40 degrees now with RVAD of 35). The ortho in Indy said to do a brace for a couple of months first, but Dr. Crawford said that was not a good idea.

We should find out tomorrow when Dr. Sanders in Erie can see her. If before June 15th, then we will go with him. We are also trying to get her into the Chicago session with Dr. Mehta June 14-15. If neither of them can cast her before June 20th, then we will go with the Risser cast and Dr. Crawford since I agree that the most important thing is to get her into some sort of treatment ASAP. Thanks so much for your insight and always helpful information.

**Celia** · 05-15-2007, 08:14 AM

You're welcome Tina! It's really difficult when you're give conflicting information which causes you to stress over minor details but common sense should prevail in the end. I wish you only the best!

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**Jacksmom** · 07-10-2007, 10:27 PM

Did you say that the Shriner's in Chicago will be doing casting soon?

**tonibunny** · 07-11-2007, 07:22 AM

May I ask, please, what the difference is between a Risser cast, a cast applied on an EDF frame and a Mehta cast?

As a child, from 1976 to 1986, I wore casts that were applied on an EDF frame at the RNOH in Stanmore, England, where Min Mehta worked. I knew her, but was under the care of her colleague Mr Edgar. The casts were solid POP covered in a layer of Scotchcast (fibreglass) with a tummy hole cut out. I had them changed every two months, though in the summer months I would wear high-profile Milwaukee braces.

Today I know of a little girl who wears exactly the same casts as I had, who is cast on the same EDF frame at Stanmore. Her casts are said to be "serial casts" and I assume they are following Mehta's Serial Casting technique, but I can't see what the difference is between the casts she wears and the casts that I wore up until the age of ten.

Any ideas? I know that Mehta started her serial casting in 1977 or 1978 and that the children she cast during her initial trial had much smaller curves than I did (diagnosed as a six month old with 62/40+ double curve, and originall put into Minerva casts that came up round my head).

Thanks!

**Celia** · 07-12-2007, 07:25 AM

Hi Toni

I honestly don't know the difference but one mom reported that doctor D'Astous who routinely applies the EDF casts referred to the casts as Risser type casts. In fact I remember seeing a picture of a child with a cast in one of Mehta's articles and the cast is very much like the one Erin and Deirdre wore with no cutouts in the front. In the following article "Non-Operative Treatment of Infantile Idiopathic Scoliosis" by Mehta and Morel they state:

"the choice of the type of corrective POP cast can be a matter of individual preference but we have found that thoracic and thoraco-lumbar curves correct best by lateral bending or by wedged casts and combined thoracic and lumbar curves by the distraction type cast. We have also found that thoraco-lumbar curves are easier to correct but thoracic curves are generally less flexible and need to be held in plaster jackets for a longer time. Combined curves can be helped to regress more speedily when active dynamic traction is also prescribed during the first stage of treatment."

You tell me whether this obsessive preoccupation by some people with the appearance of the cast is well founded!!!!

**tonibunny** · 07-12-2007, 08:34 AM

Thanks Celia

I always thought that "Risser casts" and "EDF casts" were the same thing (after all, they are applied on a Risser-Cotrel frame, and apply elongation-distraction-flexion), so it is very confusing when I read that some people believe they are different!

The Risser casts I wore as a child certainly addressed my rotation. The Risser-Cotrel casting frame has de-rotation straps for both thoracic and lumbar curves.

I wonder if there is a difference between "Risser casts" that perhaps are simple body casts that don't address the rotation, and "Risser-Cotrel" casts that do?

Tina, what are your thoughts on this? :-)

**tinamorris11** · 07-12-2007, 09:15 AM

Reply

Hi Toni,
I really don't know much about the various types of casts or the correct terminaology beyond what other parents has shared. I just know that Dr. Crawford in Cincinnati told us the type of casting he did was "Risser" style. The photos I saw showed a cast that went lower on the hips with a neck brace an cut outs. He told us that we shoudl postpone the casting as long as possible because of her age (6 months at the time) and the risk of not allowing for adequate rib expansion. However, since her curve was progressing rapidly and was hitting the 40 degree+ mark, he went ahead and scheduled her for the next month. I do not know what kind of table or equipment he used. When I asked how his cast was different from "Mehta" casts, he replied "A rose by anyother name...."?! I know there are other parents in the Yahoo chat group that went to him and had great results with is style of casting. However, the kids were a little older (2yrs approx.).

Dr. Sanders in Erie and his staff told us that the cutouts of the "Mehta" style casts allow for better rib expansion in infants and result in better correction of the rotation. I have seen the "Mehta" style casts with under arm, over arm, and over just one arm styles. Our daughter's is under the arms with a large cut out in front and a small cut out in the back. We will see how well it is working when we go back for #2 in early August.
Thanks!
Tina

**tonibunny** · 07-12-2007, 09:53 AM

Hi Tina,

I had Minerva casts (basically solid POP, no cut-outs, came up round the chin and ears and down to the hips) from the age of 6 months. I think I had these until the age of 2 and then switched to EDF/Risser-Cotrel casts, which had a cutout in the tummy but none at the back so I don't see how they'd allow for much expansion of the ribcage - I had a 62 degree high thoracic curve at 6 months so the cast had to be tight around my chest anyway. NB these casts (plus Milwaukee braces during the summer months) held my thoracic curve more or less stable until I was ten, when I had my first surgery.

No matter what the casts are called, I think the main thing is that they are applied on the EDF frame :-)

Toni x

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Doctors who Cast Infant/Young Children for Progressive Infantile Idiopathic Scoliosis

Doctors who Cast Infant/Young Children for Progressive Infantile Idiopathic Scoliosis

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