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Early Onset Scoliosis: The Value of Serial Risser Casts

Waldron, Sean R. MD; Poe-Kochert, Connie RN, CNP; Son-Hing, Jochen P. MD, FRCSC; Thompson, George H. MD

Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0000000000000072
Scoliosis
Abstract

Background: Treatment of early onset scoliosis (EOS) is challenging. In many cases, bracing will not be effective and growing rod surgery may be inappropriate. Serial, Risser casts may be an effective intermediate method of treatment.

Methods: We studied 20 consecutive patients with EOS who received serial Risser casts under general anesthesia between 1999 and 2011. Analyses included diagnosis, sex, age at initial cast application, major curve severity, initial curve correction, curve magnitude at the time of treatment change or latest follow-up for those still in casts, number of casts per patient, the type of subsequent treatment, and any complications.

Results: There were 8 patients with idiopathic scoliosis, 6 patients with neuromuscular scoliosis, 5 patients with syndromic scoliosis, and 1 patient with skeletal dysplasia. Fifteen patients were female and 5 were male. The mean age at first cast was 3.8±2.3 years (range, 1 to 8 y), and the mean major curve magnitude was 74±18 degrees (range, 40 to 118 degrees). After initial cast application, the major curve measured 46±14 degrees (range, 25 to 79 degrees). At treatment change or latest follow-up for those still in casts, the major curve measured 53±24 degrees (range, 13 to 112 degrees). The mean time in casts was 16.9±9.1 months (range, 4 to 35 mo). The mean number of casts per patient was 4.7±2.2 casts (range, 1 to 9 casts). At the time of this study, 7 patients had undergone growing rod surgery, 6 patients were still undergoing casting, 5 returned to bracing, and 2 have been lost to follow-up. Four patients had minor complications: 2 patients each with superficial skin irritation and cast intolerance.

Conclusions: Serial Risser casting is a safe and effective intermediate treatment for EOS. It can stabilize relatively large curves in young children and allows the child to reach a more suitable age for other forms of treatment, such as growing rods.

Level of Evidence: Level IV; case series.

Author Information

Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH

Presented in part at the 2010 Scoliosis Research Society Annual Meeting in Kyoto, Japan, September 22 to September 24, 2010.

None of the authors or their divisions received anything of value for this study.

The authors declare no conflicts of interest.

Reprints: George H. Thompson, MD, Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail: ght@po.cwru.edu.

© 2013 by Lippincott Williams & Wilkins