Safety and efficacy of waterproof casting for early onset scoliosis.

Autor: Conry KT; Department of Orthopaedic Surgery, Cleveland Clinic Akron General, Akron, OH, USA., Floccari LV; Department of Orthopaedics, Akron Children's Hospital, 215 West Bowery Street, Akron, OH, 44308, USA., Morscher M; Department of Orthopaedics, Akron Children's Hospital, 215 West Bowery Street, Akron, OH, 44308, USA., Brown MF; Department of Orthopaedics, Akron Children's Hospital, 215 West Bowery Street, Akron, OH, 44308, USA., Ritzman TF; Department of Orthopaedics, Akron Children's Hospital, 215 West Bowery Street, Akron, OH, 44308, USA. tritzman@akronchildrens.org.
Jazyk: angličtina
Zdroj: Spine deformity [Spine Deform] 2024 Sep; Vol. 12 (5), pp. 1459-1466. Date of Electronic Publication: 2024 Apr 13.
DOI: 10.1007/s43390-024-00868-1
Abstrakt: Purpose: The efficacy of traditional Mehta casting in the treatment of early onset scoliosis (EOS) is well-established. However, waterproof casting has not been previously described. Inherent advantages of waterproof casting include clearance for bathing/swimming, avoiding cast holidays, and improved family satisfaction. The purpose of this study was to assess the safety and efficacy of waterproof serial casting at controlling curve progression in EOS.
Methods: The current study is an IRB-approved Level IV retrospective consecutive cohort of EOS patients who underwent a serial 75% body weight traction-elongation-flexion Mehta cast protocol with waterproof cast padding. The addition of 3-point apical translation with stockinettes was utilized during casting. Bracing was initiated after correction < 15° or 1 year of serial casting.
Results: Seventeen patients at mean age 21.6 months, with pre-cast Cobb angle 52.3° (R: 35°-82°), underwent serial waterproof casting. In-cast correction index was 64%; for post-cast, Cobb angle was 18.6°. At mean 5.6 years follow-up (R: 2.3-8.9 years), 82% successfully avoided surgical intervention, 53% maintained correction < 25°, and 29% are considered "cured". 3/17 (18%) underwent a 2nd round of casting, and a total of 3/17 (18%) ultimately required surgery at 6.2 years post-casting. No major cast-related complications, decubiti, or cast holidays were encountered.
Conclusion: Serial waterproof casting is safe and efficacious in EOS when compared to published results of traditional Mehta casting. Of 17 patients with mean pre-cast Cobb 52.3°, 82% successfully avoided surgery and 53% maintained mild curves < 25° magnitude at 5.6 years follow-up. No major complications or skin decubiti occurred, and advantages include clearance for bathing and avoidance of need for cast holidays during treatment.
Level of Evidence: Level IV.
(© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)
Databáze: MEDLINE
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