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Successive Cast Correction for Idiopathic Infantile Scoliosis

New York, NY (Nov 24, 2009)


Michael G. Vitale, MD

For more than 30 years, the accepted treatment for idiopathic infantile scoliosis has been braces that are worn to straighten a curved spine. However, bracing does not generally produce good results, says Michael G. Vitale, MD, Chief of Pediatric Spine and Scoliosis Surgery at NewYork-Presbyterian Morgan Stanley Children's Hospital. The childs curvature tended to progress and the braces often caused skin issues. Treatment options for these kids were not good, and many would develop very large curves at an early age that resulted in breathing problems and even early death. Today, however, Dr. Vitale and orthopaedic colleagues around the country and the world are returning to casting, an early treatment method for idiopathic infantile scoliosis that had virtually been abandoned with the introduction of spinal instrumentation and bracing.

Dr. Min Mehta: Leading Advocate for Casting

Casting again came into prominence through the work of Min Mehta, MD, a recently retired orthopaedic surgeon from the Royal National Orthopaedic Hospital in London and Stanmore, England. For many years, Dr. Mehta had been using body casting instead of bracing, says Dr. Vitale. Over time Dr. Mehta successfully treated a large number of patients and published important papers that really changed the thinking about casting.

Dr. Mehta, who developed scoliosis as a teenager, has dedicated her life to finding a cure for idiopathic infantile scoliosis. To date she has successfully treated more than 100 infants and young children with the non-surgical series of corrective plaster casts and followed their progress for more than 10 years.

Dr. Mehta realized that casting might still have a role in the treatment of a certain subgroup of kids, typically under the age of 1, who didnt have many viable treatment options, says Dr. Vitale. The Shriners Hospital System in the United States began using the Mehta Casting Method and then other medical centers became involved. I became interested in the approach because we see a large population of children with scoliosis at an early age.

Casting Method Requires Customized Table

Dr. Vitale is among a small group of doctors around the country who has trained in the Mehta Casting Method. Though the casting treatment is non-surgical, it is performed in an operating room under general anesthesia because doctors must manipulate the spine before encasing the childs torso in a plaster cast. It also requires a customized casting table that facilitates the casting process.

You cant do the casting properly and get good results without the table, says Dr. Vitale. The table allows us to put intra-operative traction on the child and then apply a well-placed, well-padded circumferential cast around the childs torso, above the hips and usually below their shoulders. It also has a mirror under it that allows us to de-rotate the spine as we are molding corrections to the spine. Well then make openings in the cast to relieve pressure on the chest and abdomen while preventing the ribs from rotating. The child goes home the same day.

Generally a child is in the cast for about two months, continues Dr. Vitale. Then they spend a few weeks out of the cast, followed by time in the cast again. The goal is to correct the spine to a point that we can transition the child to a brace and then to a point where they dont require any further treatment. We can achieve very dramatic corrections using this method.

According to Dr. Vitale, treatment should commence as early as possible and can take up to a year or longer to complete. Childrens spines are very flexible at this age and for a child with idiopathic scoliosis, the best time to start treatment is when the curve has just started. Casting can be curative and avoid the need for surgery, he says.

Children respond amazingly well to the casting, says Dr. Vitale. They are so adaptable. Even with the cast, they can run around, play, sit in a car seat, and wear normal diapers, he says. Theres always a bit of adjustment for the families, but for the most part the kids do well. We worry about skin problems, but there are a number of things we can do to decrease the risk of skin issues, including special liners in the cast to allow moisture to wick away.

Children with other types of scoliosis, for example, congenital or neurogenic, do not respond as well with this casting method. However, as we expand our experience, we hope to be able to use casting to avoid surgery or stall it for a little longer in older kids, adds Dr. Vitale.

Contributing faculty for this article:
Michael G. Vitale, MD, Chief of Pediatric Spine and Scoliosis Surgery at NewYork-Presbyterian Morgan Stanley Children's Hospital, and the Ana Lucia Associate Professor of Clinical Pediatrics and Orthopaedic Surgery at Columbia University College of Physicians and Surgeons

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