Where surgery was the standard, casting may be the future

September 30, 2009

When parents are told their babies' scoliosis needs treatment, they often try bracing first. If that fails, they need surgery to place metal rods in their backs with spinal fusion later on. These children face the risk of complications from the surgery and their backs and chests may be stiff for life.

New research from the University of Rochester Medical Center (URMC) challenges that treatment convention and may lead doctors to choose to tweak an old technology - casting - over using high-tech implantable devices. Casting has fewer, and less serious, potential complications, and it requires no surgery. In fact, with the right training and equipment, the specialized, series of casts can be done as outpatient procedures.

"Best of all, we can cure some children with progressive infantile scoliosis, something we can't do with surgery and devices," said James O. Sanders, M.D., chief of Pediatric Orthopaedics at the URMC and author of the research published in this month's Journal of Pediatric Orthopedics. "If we cast these children before their curvatures become severe and before they turn 2, our chances of avoiding surgery and potentially curing them are much better."

The study followed 55 patients with progressive infantile scoliosis (or early-onset scoliosis) a rare and potentially fatal form of spinal curvature, at Shriners Hospitals for Children in Erie, Pa., Salt Lake City and Chicago. Pediatric orthopaedic specialists used a method of casting, called EDF (for extension, derotation and flexion) that capitalizes on children's rapid growth to untwist and un-curve their spines over time. The method uses a specialized table and casts with strategically placed holes Sanders and URMC colleague Paul Rubery, M.D., an orthopaedic surgeon, are two of only a handful of surgeons nationwide who use this specialized method with the goal of curing, not just delaying surgery.

Children are given anesthesia and ventilated during the casting because the pressure on the chest during the procedure can make breathing difficult. The cast may extend over the shoulders like a tank-top and down to the pelvis, but large holes are left open between to relieve pressure on the chest and abdomen while preventing the ribs from rotating. The entire procedure can take less than an hour. Depending on the child's age and severity of the curvature, the series of casts (removed and refitted every eight to 12 weeks) could be completed in about two years.

Although the casts can be restrictive and cause some trouble with mobility, initially, Sanders said parents are almost always surprised by how quickly their children adapt and how little having a cast changes their lives. Children can't swim or be immersed in a bath, but they are otherwise unrestricted in their activities.

Current treatments, such as the vertical expandable prosthetic titanium rib (VEPTR), which are attached to the inside of the ribs and adjusted over time, and growing rods, which are inserted near the spine and lengthened over time, are aimed at delaying spinal fusion. They are not meant to be a cure for the disease, and they present a whole host of potential complications, such as infection, pulling loose and causing stiffness in the chest and back.

"Casting remains the only method which can cure some of these curves," Sanders said.

But casting doesn't cure all curvatures and some children may still require growing rods of the VEPTR. Among children in this study a little more than 10 percent saw their curves worsen and they needed surgery. Sanders said his future research will focus on finding the best treatment options for these children, for older children and for those with large curvatures.
-end-


University of Rochester Medical Center

Related Children Articles from Brightsurf:

Black and Hispanic children in the US have more severe eczema than white children
A presentation at this year's virtual American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting reveals the disparities that exist for Black and Hispanic children when it comes to Atopic Dermatitis (AD), commonly known as eczema.

Black children with cancer three times less likely to receive proton radiotherapy than White children
A retrospective analysis led by investigators from Brigham and Women's Hospital has found racial disparities in the use of the therapy for patients enrolled in trials.

The Lancet Child & Adolescent Health: First Europe-wide study of children confirms COVID-19 predominately causes mild disease in children and fatalities are very rare
Children with COVID-19 generally experience a mild disease and fatalities are very rare, according to a study of 582 patients from across Europe published today in The Lancet Child & Adolescent Health journal.

Children not immune to coronavirus; new study from pandemic epicenter describes severe COVID-19 response in children
- While most children infected with the novel coronavirus have mild symptoms, a subset requires hospitalization and a small number require intensive care.

How many children is enough?
Most Russians would like to have two children: a boy and a girl.

Preterm children have similar temperament to children who were institutionally deprived
A child's temperament is affected by the early stages of their life.

Only-children more likely to be obese than children with siblings
Families with multiple children tend to make more healthy eating decisions than families with a single child.

Children living in countryside outperform children living in metropolitan area in motor skills
Residential density is related to children's motor skills, engagement in outdoor play and organised sports. that Finnish children living in the countryside spent more time outdoors and had better motor skills than their age peers in the metropolitan area.

Hispanic and black children more likely to miss school due to eczema than white children
In a study that highlights racial disparities in the everyday impact of eczema, new research shows Hispanic and black children are more likely than white children to miss school due to the chronic skin disease.

Children, their parents, and health professionals often underestimate children's higher weight status
More than half of parents underestimated their children's classification as overweight or obese -- children themselves and health professionals also share this misperception, according to new research being presented at this year's European Congress on Obesity (ECO) in Glasgow, UK (April 28-May 1).

Read More: Children News and Children Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.