EDF Casting for Early Onset Scoliosis: What We Learned From 175 Castings. Issue 13 (1st July 2021)

• Record Type: Journal Article
• Authors: Shafer, Cody; Mahajan, Rajat; Kishan, Shyam
• Is Part Of: Spine. Volume 46:Issue 13(2021)
• Publication Date: 2021-07-01
• Subjects: early onset scoliosis -- EDF casting -- EOS -- Mehta casting -- pulmonary function; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000003941
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: IRB approved prospective case series. Objectives: This study attempts to determine the effects of elongation, derotation, and flexion (EDF) casting on pulmonary function. We also attempted to define prognostic factors and determine the ideal amount of traction for casting in patients with early onset scoliosis (EOS). Summary of Background Data: No literature on effects of serial casting on pulmonary parameters in EOS, or on the ideal amount of traction to be used for EOS Casting. Methods: Fifty consecutive children with EOS treated by the senior author using EDF casting were studied prospectively. Traction and lung function parameters (compliance, tidal volume, peak inspiratory pressure, and resistance) were measured at different periods during cast application. Etiology, age, weight, Cobb angles, and RVAD were monitored. Results: All lung function parameters decline during cast application but rise to near baseline levels at the time of next cast application. Near full curve correction was achieved in every patient with (A) idiopathic scoliosis who (B) presented prior to 20 months of age with (C) a moderate main curve at presentation (<45°) and in those (D) without a phase II rib-vertebral relationship at presentation. The best response to casting was seen with 1 pound traction per pound body weight during application. Conclusion: EDF casting can delay progression or improve curves in patients with larger curves, nonidiopathic scoliosis, and older patients. Idiopathic patients, moderate curve sizes, and younger patients had a better response to casting. Even though lung function declines during cast application, it returns to near baseline levels at the time of the next cast application, suggesting that EDF casting may not have any long-term effects on lung function, and also may protect pulmonary function in EOS from its natural history of progressive deterioration. Level of Evidence: 4 Abstract : We present the pulmonary changes to be expected during EDF casting for EOS, and the importance of traction in EDF casting. Serial casting preserves pulmonary function thus altering the natural history in EOS. While casting, traction of one pound/pound body weight is recommended for ideal results without complication.