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Derotational Casting for Progressive Infantile Scoliosis

Sanders, James O. MD*; D'Astous, Jacques MD; Fitzgerald, Marcie PA-C; Khoury, Joseph G. MD§; Kishan, Shyam MD; Sturm, Peter F. MD

Journal of Pediatric Orthopaedics: September 2009 - Volume 29 - Issue 6 - pp 581-587
doi: 10.1097/BPO.0b013e3181b2f8df
Lower Extremity

Background: Serial cast correction by using the Cotrel derotation technique is one of several potential treatments for progressive infantile scoliosis. This study reviews our early experience to identify which, if any, patients are likely to benefit from or fail this technique.

Methods: We followed all patients treated at our institutions for progressive infantile scoliosis since 2003 prospectively at 1 institution and retrospectively at the other 2. Data, including etiology, Cobb angles, rib vertebral angle difference, Moe-Nash rotation, and space available for the lung, were recorded over time.

Results: Fifty-five patients with progressive infantile scoliosis had more than 1 year of follow-up from the initiation of casting. The diagnosis of progressive scoliosis was made based upon either a progressive Cobb angle or a rib vertebral angle difference of more than 20 degrees at presentation. All but 6 patients responded to cast correction. Nine patients have undergone surgery to date, 6 because of worsening and 3 by parent choice. As shown in the table, initiation of cast correction at a younger age, moderate curve size (<60 degrees), and an idiopathic diagnosis carry a better prognosis than an older age of initiation, curve >60 degrees, and a nonidiopathic diagnosis. The space available for the lung improved from 0.89 to 0.93. No patient experienced worsening of rib deformities.

Conclusions: Serial cast correction for infantile scoliosis often results in full correction in infants with idiopathic curves less than 60 degrees if started before 20 months of age. Cast correction for older patients with larger curves or nonidiopathic diagnosis still frequently results in curve improvement along with improvement in chest and body shape.

Significance: Derotational cast correction seems to play a role in the treatment of progressive infantile scoliosis with cures in young patients and reductions in curve size with a delay in surgery in older and syndromic patients.

Level of Evidence: Level 4, therapeutic study.

*Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY

Shriners Hospitals for Children, Salt Lake City, UT

Shriners Hospitals for Children, Erie, PA

§Orthopedic Surgery, University of Alabama, Birmingham, AL

Orthopedics, Loma Linda University, Loma Linda, CA

Shriners Hospitals for Children, Chicago, IL

None of the authors received financial support for this study.

Reprints: James O. Sanders, MD, Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. E-mail: James_sanders@urmc.rochester.edu

© 2009 Lippincott Williams & Wilkins, Inc.