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Bonsignore-Opp L, Malka MS, Ball J, Simhon ME, Matsumoto H, Sturm P, Pahys JM, Vitale MG, Larson AN, Roye BD. Institutional Variability in Anesthesia Time for Mehta Casting in Early-Onset Scoliosis (EOS). J Pediatr Orthop 2024; 44:297-302. [PMID: 38353100 PMCID: PMC11018351 DOI: 10.1097/bpo.0000000000002644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE Mehta casting is a potentially curative intervention for early-onset scoliosis (EOS) that typically requires multiple anesthetics. The Food and Drug Administration (FDA) reported that >3 hours of anesthesia under the age of 3 years old may alter brain development; however, no standard exists for the duration of anesthesia during casting. The purpose of this study is to quantify the variability in anesthesia during Mehta casting. We hypothesize that significant institutional variability exists and may be attributed to modifiable factors. METHODS An EOS registry was used to identify patients who underwent at least one Mehta casting procedure. Anesthesia exposure was quantified, and site variability was assessed by patient characteristics, cast placement, procedure type, and equipment used. RESULTS Our cohort consisted of 208 patients from 5 institutions (age 2.6±1.4 y). There were 1097 Mehta casting procedures, with 5.4±3.6 castings per patient. Of these patients, 106 (51%) were female, with an average age of 2.11±1.29 years old at the time casting was initiated. Patient etiologies included 154 idiopathic (74.0%), 22 syndromic (10.6%), 18 congenital (8.7%), 11 neuromuscular (5.3%), and 3 unknown (1.4%). Anesthesia time was 69±31 minutes and varied significantly between sites (59±14 to 117±46 min; P <0.001). Cumulative anesthesia time for patients under 3 years was 320±197 minutes with 120/161 (74.5%) patients exceeding 3 hours. Anesthesia time was lower after the FDA warning in 2016 compared with pre-2016 (71±30 vs. 66±32, P =0.008). CONCLUSIONS Patients undergoing Mehta casting are at significant risk of exceeding 3 hours of anesthesia, which the FDA has stated may be harmful for children <3 years. Significant site variability indicates that standardization protocols should be developed to encourage best practices and minimize anesthetic times. LEVEL OF EVIDENCE Prognostic Level II.
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Affiliation(s)
- Lisa Bonsignore-Opp
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY USA
- Department of Orthopedic Surgery, University of California San Francisco, CA USA
| | - Matan S. Malka
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY USA
| | - Jacob Ball
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY USA
| | - Matthew E. Simhon
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY USA
| | - Hiroko Matsumoto
- Department of Orthopedic Surgery and Sports Medicine, Boston Children’s Hospital, Boston, MA USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA USA
| | - Peter Sturm
- Department of Orthopedic Surgery, Cincinnati Children’s Hospital, Cincinnati, OH USA
| | - Joshua M. Pahys
- Orthopedic Surgery, Shriners Hospital for Children, Philadelphia, PA USA
| | - Michael G. Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY USA
- Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, NY USA
| | | | - Benjamin D. Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY USA
- Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, NY USA
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Zhang H, Han B, Li Z, Zhao Y, Du Y, Yang Y, Wang S, Zhang J. The role and mechanism of inflammatory response to growing rod implantation in early onset scoliosis. Front Cell Dev Biol 2023; 11:1282573. [PMID: 37965575 PMCID: PMC10642228 DOI: 10.3389/fcell.2023.1282573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023] Open
Abstract
Growing rod implantation, a surgery treatment for EOS (early onset scoliosis), may cause a kind of chronic inflammation called metalosis and all other implant-related complications because of the metal debris released by the implants as a result of fraction and corrosion. There is no complete explanation of immunologic mechanisms of metalosis up to now. This review demonstrates the researches on metalosis from the clinical issues down to basic immunologic mechanisms. Adverse reactions of metal implants are mainly the formation of NLRP3 (nod-like receptor protein 3) inflammasome, primed by TLR4 (toll-like receptor protein 4), activated by phagocytosis and often accompanied by type Ⅳ hypersensitive reaction. Recent studies found that TNF-α (tumor necrosis factor α) also participates in priming, and activation of inflammasome requires disturbance of lysosome and release of cathepsin B. Ca-074Me and MCC950 are therapeutic interventions worth exploring in aseptic loosening of orthopedic implants.
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Affiliation(s)
| | | | | | | | | | | | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Regan CM, Milbrandt TA, Stans AA, Grigoriou E, Larson AN. Minimum 5-Year Results of Elongation Derotation Flexion Casting for Early Onset Scoliosis: The Story Is Not Over Until Skeletal Maturity. J Pediatr Orthop 2023; Publish Ahead of Print:01241398-990000000-00313. [PMID: 37367699 DOI: 10.1097/bpo.0000000000002457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Early conservative treatment for patients with idiopathic infantile scoliosis (IIS) with elongation derotation flexion (EDF) casting and subsequent serial bracing has become widely utilized. However, the long-term outcomes of patients treated with EDF casting are limited. METHODS We performed a retrospective chart review of all patients who had undergone serial elongation derotation flexion casting and subsequent bracing for scoliosis presenting at a single large tertiary center. All patients were followed for a minimum of 5 years or until surgical intervention. RESULTS Our study included 21 patients diagnosed with IIS and treated with EDF casting. At a mean 7-year follow-up, 13 of the 21 patients were considered successfully treated with a mean final major coronal curvature of 9 degrees compared to a pretreatment coronal curve of 36 degrees. These patients, on average, began casting at 1.3 years old and spent 1 year in a cast. Patients that did not have substantial improvement began casting at mean 4 years old and remained in a cast for 0.8 years. Three patients initially had substantial improvement with the correction to <20 degrees at a mean age of 7; however, their curves worsened in adolescence with poor brace compliance. All 3 patients will require surgical intervention. Of the patients not successfully treated with casting, 7 required surgery at a mean 8.2 years of age, 4.3 years after initiation of casting. A significant predictor of treatment failure was older age of cast initiation (P<0.001). CONCLUSIONS EDF casting can be an effective cure for IIS patients if initiated at a young age with 15 of 21 patients successfully treated (76%). However, 3 patients had a recurrence in adolescence resulting in an overall success rate of only 62%. Casting should be initiated early to maximize the likelihood of treatment success and periodic monitoring should be continued through skeletal maturity as recurrence during adolescence can occur.
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Does Transitioning to a Brace Improve HRQoL After Casting for Early Onset Scoliosis? J Pediatr Orthop 2023; 43:151-155. [PMID: 36728464 DOI: 10.1097/bpo.0000000000002347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Serial casting is favored for the initial treatment of early onset scoliosis (EOS), but there is concern about significant morbidity and caregiver burden. Studies have examined the utility of bracing as an alternative to casting, but little is known about differences in health-related quality of life (HRQoL) between treatments. We hypothesized that patients with a diagnosis of idiopathic EOS experience an improvement in HRQoL when transitioning from serial casting to bracing as measured by the 24-Item Early Onset Scoliosis Questionnaire (EOSQ). METHODS Subjects with idiopathic EOS were retrospectively identified from a multicenter database. EOSQ scores were compared before treatment, after index casting, after transition out of cast to brace, and at the most recent follow-up. Available major curve magnitudes were also compared during these time points. Data were compared using repeated-measures ANOVA with post hoc Bonferroni correction. RESULTS Sixty-six subjects met the inclusion criteria. Thirty-seven (56%) subjects were male and the average age at the time of index treatment was 1.9 (0.37-6.4) years. The average follow-up was 3.2 (0.90-6.8) years. In 57 subjects, the major curve magnitude improved from a mean of 33 (CI 28-37) degrees before treatment initiation to 27 (CI 23-30) degrees after casting and to 24 (CI 20-29) degrees at the most recent follow-up. The HRQoL subdomain showed a significant decrease in HRQoL during casting treatment 75.7 (CI 72.9-78.5) from pre-index treatment 84.9 (CI 81.4-88.5), during brace treatment 84.8 (CI 81.8-88.0) and at most recent follow-up 87.0 (CI 83.6-90.3) ( P <0.001). The parental impact subdomain improved from the beginning to the end of treatment (77.7 to 87.7, P =0.001) (n=64). Satisfaction improved from casting to bracing (73.4 to 86.7, P <0.001) (n=63) and to the most recent follow-up (73.4 to 87.9, P <0.001). CONCLUSION Patients treated with casting for EOS experience reversible declines in HRQoL. After patients transition from casting to bracing, EOSQ scores recover to pretreatment baseline levels and are maintained at follow-up. This information must be balanced with the effectiveness of treatment for EOS with either method and customized for each patient. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Montgomery BK, Tileston K, Kaur J, Kym D, Segovia NA, Imrie M, Policy J, Rinsky L, Vorhies J. Innovative technique for early-onset scoliosis casting using Jackson table. Spine Deform 2022; 10:1461-1466. [PMID: 35776363 DOI: 10.1007/s43390-022-00526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Early-onset scoliosis (EOS) can have harmful effects on pulmonary function. Serial elongation, derotation, and flexion (EDF) casting can cure EOS or delay surgical intervention. Most described casting techniques call for specialized tables, which are not available at many institutions. We describe an innovative technique for EDF casting utilizing a modified Jackson table (MJ) and compare results to a Risser frame (RF). METHODS All patients who underwent EDF casting at our institution between January 2015 and January 2019 were identified and retrospectively reviewed. Patients were stratified by type of table used and clinical and radiographic outcomes were compared. Standard descriptive statistics were calculated. RESULTS We identified 25 patients who underwent 77 casting events, 11 on an MJ table and 14 on a RF. Mean follow-up was 32 months (range 11-61 months). 28% of patients had idiopathic scoliosis. There was no significant difference in age at initiation of casting (P = 0.3), initial Cobb angle (equivalence, P = 0.009), or rate of idiopathic scoliosis between the MJ and RF groups. There was no significant difference in initial coronal Cobb angle percent correction (equivalence, P = 0.045) or percent correction at 1-year follow-up (equivalence, P = 0.010) between the two groups. There was no difference in cast related complications. There was a significant difference in surgical time, with the MJ group 11 min shorter than the RF (P = 0.005). CONCLUSION The MJ table is a safe and effective alternative for applying EDF casts under traction without the need for a specialized table. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Blake K Montgomery
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
| | - Kali Tileston
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Japsimran Kaur
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Dan Kym
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Nicole A Segovia
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Meghan Imrie
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - James Policy
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Lawrence Rinsky
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - John Vorhies
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA.
- Lucile Packard Children's Hospital, Palo Alto, CA, USA.
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Marrache M, Prasad N, Thompson GH, Li Y, Glotzbecker M, Sponseller PD. Outcomes for patients with infantile idiopathic scoliosis by casting table type. J Child Orthop 2022; 16:285-289. [PMID: 35992520 PMCID: PMC9382706 DOI: 10.1177/18632521221115934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Serial casting is an effective treatment for infantile idiopathic scoliosis. The most common casting table types are Mehta, Risser, and spica tables. We compared major curve correction between patients with infantile idiopathic scoliosis treated using pediatric hip spica tables versus Risser or Mehta tables. METHODS In this multicenter retrospective study, we included 52 children younger than 3 years (mean ± standard deviation age, 1.6 ± 0.68 years) treated with ≥2 consecutive casts for infantile idiopathic scoliosis between September 2011 and July 2018. We compared major curve angle (measured using the Cobb method) before and after treatment and improvement in curve angle between the spica tables group (n = 12) and the Risser or Mehta tables group (n = 40). The primary outcome was the difference in percentage correction of the major curve according to radiographs taken after first casting and at final follow-up. RESULTS The mean major curve was 47° ± 18° before casting. A median of six casts (range: 2-14) were applied. Mean follow-up after treatment initiation was 22 months (range: 7-86 months). At baseline, the major curve was significantly larger in the spica tables group (58°) than in the Risser or Mehta tables group (43°) (p = 0.01). We found no differences in the percentage curve correction in the spica tables group versus Risser or Mehta tables group after first casting or at final follow-up. CONCLUSION Serial casting was associated with substantial major curve correction in patients with infantile idiopathic scoliosis. Curve correction did not differ between patients treated with a spica table versus a Risser or Mehta table. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Majd Marrache
- Department of Orthopaedic Surgery, The
Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Niyathi Prasad
- Department of Orthopaedic Surgery, The
Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George H Thompson
- Rainbow Babies and Children’s Hospital,
Case Western Reserve University School of Medicine, University Hospitals Case
Medical Center, Cleveland, OH, USA
| | - Ying Li
- Department of Orthopaedic Surgery, C.
S. Mott Children’s Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Michael Glotzbecker
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Boston, MA, USA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The
Johns Hopkins University School of Medicine, Baltimore, MD, USA,Paul D Sponseller, Department of
Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N.
Caroline Street, JHOC 5223, Baltimore, MD 21287, USA.
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Ulusaloglu AC, Asma A, Rogers KJ, Bowen JR, Mackenzie WG, Mackenzie WGS. Elongation-Derotation-Flexion Casting Treatment of Early-Onset Progressive Scoliosis in Skeletal Dysplasia. J Pediatr Orthop 2022; 42:e229-e233. [PMID: 34967803 DOI: 10.1097/bpo.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early-onset scoliosis in children with skeletal dysplasia is progressive, contributing to cardiopulmonary restrictive disease. Serial elongation-derotation-flexion (EDF) casting, used in other etiologies of scoliosis to delay curve progression, may be beneficial in maximizing spine growth. Our hypothesis is serial EDF casting can be safely used as a temporary alternative to surgery, delaying progression and preserving growth, to treat scoliosis in skeletal dysplasia. METHODS All patients with skeletal dysplasia treated at a single institution with serial EDF casting for scoliosis were reviewed retrospectively. Radiographic parameters: Cobb angle of major and minor curves, curve location, thoracic height, thoracolumbar height, space available for lung, and rib vertebra angle difference were measured before casting (C1), in first casting (C2), in last casting (C3), and out of last casting (C4). Peak inspiratory pressure (PIP) values were monitored and recorded during the casting application. RESULTS Eleven patients met the inclusion criteria (mean 9.7 castings). The mean duration of EDF serial casting was 35 months. The mean major Cobb angles were 54 degrees° (C1), 30 degrees (C2), 37 degrees (C3), and 49 degrees (C4) with no statistically significant differences. The mean minor Cobb angles were 35 degrees (C1), 25 degrees (C2), 33 degrees (C3), and 51 degrees (C4) with no statistically significant differences. The mean thoracic heights were 130 mm (C1), 155 mm (C2), 173 mm (C3), and 160 mm (C4). The 19-mm mean difference between C2 and C3 represents spinal growth. The PIP-1, PIP-2, and PIP-3 mean values were 15, 27, and 18 cmH2O, respectively. Changes in PIP-1 and PIP-2 and PIP-2 and PIP-3 were statistically significant. CONCLUSION Serial EDF casting can delay surgical scoliosis correction in children younger than 7 years with a diagnosis of skeletal dysplasia. Our study showed that serial casting controls progression of the major curve and allows longitudinal growth of the spine with possible expansion of lung volume for nearly 3 years. During cast application, PIP increased with molding and traction, and improved until windowing and trimming of the cast. LEVEL OF EVIDENCE Level IV-retrospective study.
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Sugawara R, Kikkawa I, Watanabe H, Taki N, Tomisawa H, Takeshita K. Clinical Results of Corrective Cast and Brace Treatment for Early-onset Scoliosis: The Effectiveness of Long-term Cast Treatment That Extends into Children's Schooldays. J Pediatr Orthop 2021; 41:e635-e640. [PMID: 34183617 DOI: 10.1097/bpo.0000000000001888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cast and brace treatment is a conservative treatment for early-onset scoliosis (EOS). We analyzed the clinical results of this treatment when extended into patients' schooldays. METHODS Twenty-two children with EOS underwent alternatively repetitive cast and brace treatment (ARCBT). Cast was applied under general anesthesia and remained for some weeks, and the brace was continuously worn, which was repeatedly applied when scoliosis progressed. The change in the major curve angle, requirement for surgical intervention, and complications of ARCBT were analyzed. RESULTS Six patients had idiopathic scoliosis (IS), 9 had syndromic scoliosis (SS), and 7 had neuromuscular scoliosis. Cast treatment started at 4.9±2.1 years of age, and the patients were followed up for 8.3 years. The average total number of cast applications was 5.5 per patient. The mean major scoliosis angle was 45.4±12.5 degrees at the first visit; this was corrected to 26.5±8.7 degrees at the first cast application and progressed to 75.4±22.1 degrees at the final visit. Nine patients whose scoliosis progressed finally underwent surgery. The mean age at surgery was 11.0 years (range, 8.8 to 13.1 y), and the mean period from first cast application to surgery was 6.1 years (range, 5.0 to 8.9 y). Four patients' IS rapidly progressed after 9 years of age, and all of them underwent final fusion surgery with a correction rate of 56.9%. Among patients with SS, 1 final fusion, and 2 growth-friendly surgeries were performed at a mean age of 9.2 years; the correction rate was 21.5%. Among patients with neuromuscular scoliosis, 2 final fusion surgeries were performed at a mean age of 11.3 years; the correction rate was 30.7%. The cast-related complication rate was 5.0%, and most complications were skin problems. CONCLUSIONS Long-term ARCBT extended into schooldays might be effective for IS. This should be considered as a time-saving treatment option for EOS. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Ryo Sugawara
- Department of Orthopedic Surgery, Jichi Medical University
| | - Ichiro Kikkawa
- Department of Pediatric Orthopedics, Jichi Children's Medical Center Tochigi, Shimotsuke, Tochigi, Japan
| | - Hideaki Watanabe
- Department of Pediatric Orthopedics, Jichi Children's Medical Center Tochigi, Shimotsuke, Tochigi, Japan
| | - Naoya Taki
- Department of Pediatric Orthopedics, Jichi Children's Medical Center Tochigi, Shimotsuke, Tochigi, Japan
| | - Hiroko Tomisawa
- Department of Pediatric Orthopedics, Jichi Children's Medical Center Tochigi, Shimotsuke, Tochigi, Japan
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EDF Casting for Early Onset Scoliosis: What We Learned From 175 Castings. Spine (Phila Pa 1976) 2021; 46:852-860. [PMID: 33428365 DOI: 10.1097/brs.0000000000003941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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.
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Abstract
Management of scoliosis in young children needs a comprehensive approach because of its complexity. There are many debatable points; however, only serial casting, growing rods (including traditional and magnetically controlled) and anterior vertebral body tethering will be discussed in this article.Serial casting is a time-gaining method for postponing surgical interventions in early onset scoliosis, despite the fact that it has some adverse effects which should be considered and discussed with the family beforehand.Use of growing rods is a growth-friendly surgical technique for the treatment of early onset spine deformity which allows chest growth and lung development. Magnetically controlled growing rods are effective in selected cases although they sometimes have a high number of unplanned revisions.Anterior vertebral body tethering seems to be a promising novel technique for the treatment of idiopathic scoliosis in immature cases. It provides substantial correction and continuous curve control while maintaining mobility between spinal segments. However, long-term results, adverse effects and their prevention should be clarified by future studies. Cite this article: EFORT Open Rev 2020;5:753-762. DOI: 10.1302/2058-5241.5.190087.
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Affiliation(s)
- Alpaslan Senkoylu
- Gazi University, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Rolf B. Riise
- Oslo University Hospital, Orthopaedic Clinic, Oslo, Norway
| | | | - Ilkka Helenius
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Mahajan R, Kishan S, Mallepally AR, Shafer C, Marathe N, Chhabra HS. Evolution of casting techniques in early-onset and congenital scoliosis. J Clin Orthop Trauma 2020; 11:810-815. [PMID: 32879567 PMCID: PMC7452255 DOI: 10.1016/j.jcot.2020.06.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Rajat Mahajan
- Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, 110070, India
| | - Shyam Kishan
- Pediatric Orthopedics and Pediatric Orthopedic Trauma, Medical City Dallas Childrens Hospital, Southwest Pediatric Orthopedics, Southwest Scoliosis Institute, 7777 Forest Lane, Suite C-135, Dallas, TX, 75230, USA
| | - Abhinandan Reddy Mallepally
- Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, 110070, India
| | - Cody Shafer
- Pediatric Orthopedics and Pediatric Orthopedic Trauma, Medical City Dallas Childrens Hospital, Southwest Pediatric Orthopedics, Southwest Scoliosis Institute, 7777 Forest Lane, Suite C-135, Dallas, TX, 75230, USA
| | - Nandan Marathe
- Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, 110070, India
| | - Harvinder Singh Chhabra
- Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, 110070, India
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Ahmad AA. Early onset scoliosis and current treatment methods. J Clin Orthop Trauma 2020; 11:184-190. [PMID: 32099277 PMCID: PMC7026566 DOI: 10.1016/j.jcot.2019.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Provide an update of the management options for early onset scoliosis patients, including general assessment, conservative and surgical options. METHODS We included the updated information about the assessment and management options of Early Onset Scoliosis, taking into consideration the non-fusion methods, including the burden on the patient and their family. RESULTS With the heterogeneity of this population, it is difficult to get a consensus about a unified protocol for management. Accordingly, the surgeon dealing with these cases needs to be aware of the broad range of surgical and non-surgical methods when treating these patients. CONCLUSION The main aim of early onset scoliosis treatment is to gain a flexible spine associated with normal lung development and thoracic growth. Management needs to be individualized between the surgeon and patient in relation to the etiology and patient conditions.
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Serial casting in early onset scoliosis: syndromic scoliosis is no contraindication. BMC Musculoskelet Disord 2019; 20:554. [PMID: 31747883 PMCID: PMC6868715 DOI: 10.1186/s12891-019-2938-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/08/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Serial casting is a treatment for early onset scoliosis (EOS) in young children to achieve curve correction before bracing or to postpone initial surgical treatment until the patient is older. Good results have been reported for patients with idiopathic early onset scoliosis (IS). However, there are few reports of results in non-idiopathic cases, and the benefits of non-surgical methods in the syndromic-associated early onset scoliosis subgroup are unknown. METHODS Retrospective single-institution study of patient charts and X-rays of all cases of sustained serial casting for EOS. Staged correction was obtained by applying three consecutive casts under general anaesthesia. These were changed every 4 weeks, followed by the implementation of a custom-made full-time Chêneau brace. Correction was measured by Cobb angle (CA) and rib-vertebra angle difference (RVAD) on whole spine anterior-posterior radiographs. Statistical analysis was performed via ANOVA. RESULTS The study group consisted of 6 patiens with IS and 10 with non-idiopathic scoliosis (NIS) - exclusively syndromic-associated. The mean age at onset of treatment was 35 months (±15). The mean follow up was 21 months (±15). In IS patients average CA/RVAD before treatment was 46°(±8)/20°(±12). In NIS patients average CA/RVAD before treatment was 55°(±15)/24°(±14). After application of the third cast, the CA/RVAD was reduced to 20°(±11)/11°(±10) in IS patients. Whereas in NIS patients average CA/RVAD after the thrid cast was 28°(±12)/18°(±13). At latest follow-up the CA/RVAD was 16°(±7)/9°(±8) in IS patients and 31°(±11)/17° (±15) in NIS patients. CONCLUSION Syndromic etiology is not a contraindication for serial casting in EOS. Our results show a curve correction, measured in CA, of 65% in IS patients and 44% in NIS patients. Significant reduction in the morphologic deformity, measured in RVAD, was achieved in the IS cohort, but not in the NIS cohort. In all cases surgical treatment could be delayed.
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Gawliński P, Pelc M, Ciara E, Jhangiani S, Jurkiewicz E, Gambin T, Różdżyńska-Świątkowska A, Dawidziuk M, Coban-Akdemir Z, Guilbride D, Muzny D, Lupski J, Krajewska-Walasek M. Phenotype expansion and development in Kosaki overgrowth syndrome. Clin Genet 2018; 93:919-924. [DOI: 10.1111/cge.13192] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/19/2017] [Accepted: 11/20/2017] [Indexed: 01/09/2023]
Affiliation(s)
- P. Gawliński
- Department of Medical Genetics; Institute of Mother and Child; Warsaw Poland
| | - M. Pelc
- Department of Medical Genetics; The Children's Memorial Health Institute; Warsaw Poland
| | - E. Ciara
- Department of Medical Genetics; The Children's Memorial Health Institute; Warsaw Poland
| | - S. Jhangiani
- Human Genome Sequencing Center; Baylor College of Medicine; Houston Texas
| | - E. Jurkiewicz
- Department of Diagnostic Imaging; The Children's Memorial Health Institute; Warsaw Poland
| | - T. Gambin
- Department of Medical Genetics; Institute of Mother and Child; Warsaw Poland
- Institute of Computer Science; Warsaw University of Technology; Warsaw Texas
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas
| | | | - M. Dawidziuk
- Department of Medical Genetics; Institute of Mother and Child; Warsaw Poland
| | - Z.H. Coban-Akdemir
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas
| | | | - D. Muzny
- Human Genome Sequencing Center; Baylor College of Medicine; Houston Texas
| | - J.R. Lupski
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas
- Human Genome Sequencing Center; Baylor College of Medicine; Houston Texas
- Texas Children's Hospital; Houston Texas
| | - M. Krajewska-Walasek
- Department of Medical Genetics; The Children's Memorial Health Institute; Warsaw Poland
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