Evolution of casting techniques in early-onset and congenital scoliosis

Rajat Mahajan, Shyam Kishan, Abhinandan Reddy Mallepally, Cody Shafer, Nandan Marathe, Harvinder Singh Chhabra, Rajat Mahajan, Shyam Kishan, Abhinandan Reddy Mallepally, Cody Shafer, Nandan Marathe, Harvinder Singh Chhabra

Abstract

Casting is being utilized as a therapeutic strategy in some mild to moderate cases obviating surgical intervention for management of early-onset scoliosis (EOS). Bracing, another conservative modality, applies comparable correcting forces on chest wall and axial skeleton. But cast application carries additional advantage of sustained restorative force which bypasses issue of compliance seen with brace wear. There is no specific blanket treatment, conservative or surgical, for the early-onset spinal deformities. Serial cast application provides near total correction of less severe curves (less than 500 to 600) if treatment is initiated before age of 2 yrs. In this review article, we will assess the evolution of plaster cast application in management of EOS and also describe technique of EDF (Elongation- Derotation- Flexion) casting.

Keywords: Body cast; EOS; Elongation -Derotation -Flexion (EDF); Mehta; Plaster of Paris; Risser.

Conflict of interest statement

The authors disclose NO conflict of interest.

© 2020 Delhi Orthopedic Association. All rights reserved.

Figures

Fig. 1
Fig. 1
(A) Whole spine X-ray of an 8-month old child with Cobb angle of 520 and RVAD of 390. (B) Corrective casting showing significant decrease in the magnitude of the curve. (C) Anteroposterior X-ray at 5 years 3 months showing near complete correction of the scoliosis.
Fig. 2
Fig. 2
(A)Anteroposterior X-ray of whole spine of an 11-month old child with poor weight gain and developmental delays. (B) Observing for 5 months after diagnosis of scoliosis, after five serial corrective casts at age 3 showing correction of scoliotic deformity and improvement in lung shadow.
Fig. 3
Fig. 3
Positioning in the casting frame with the extremities supported but the body left free for cast application. Traction applied through the head halter and through the pelvis.
Fig. 4
Fig. 4
Scale connected to head harness utilized to measure the amount of traction applied.
Fig. 5
Fig. 5
Post-cast application windowing. Large windows created in areas not necessary for deformity correction.

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