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Early Onset Scoliosis: The Value of Serial Risser Casts: Paper #84

Waldron, Sean R. MD; Poe‐Kochert, Connie BSN; Son‐Hing, Jochen P. MD, FRCSC; Thompson, George H. MD

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United States

Summary: Sixteen consecutive patients with EOS who failed orthotic treatment were successfully stabilized with serial Risser casts until they were older or larger and changed to other methods of treatment (orthoses, growing rod surgery, etc.).

Introduction: The treatment of progressive early‐onset scoliosis (EOS) is challenging. In many cases, particularly very young or small patients, orthotic management will not be effective and growing rod surgery may not be appropriate. Serial Risser cast placement may be a safe and effective intermediate method of treatment in these select patients. We conducted a retrospective review of our results of serial Risser casting in the treatment of EOS.

Methods: Sixteen consecutive patients with progressive EOS were treated with serial Risser casting between 1999 and 2008. We analyzed the patient's age, gender, diagnosis, previous treatment, curve magnitude at the initiation of Risser casting, the number of casts, their response to casting, and their transition to treatment methods.

Results: There were 8 patients with idiopathic scoliosis, 5 patients with syndromic scoliosis, and 3 patients with neuromuscular scoliosis. There were 14 females and 2 males. Their mean age at initial cast application was 3.4 years (range, 1 to 8 years). The mean curvature at initial casting was 73° (range, 40 to 118°) and at the last cast application 45° (range, 20 to 95°). The mean length of cast treatment was 18.4 months (range, 8 to 35 months). There were 3 minor complications (skin irritation) associated with cast placement. These healed uneventfully and without scarring. Currently, 4 patients have undergone growing rod surgery, 4 patients are now being braced, 6 patients are still undergoing casting, and one patient each has undergone final fusion and has been lost to follow‐up.

Conclusion: Our results support serial Risser casting as a safe, effective intermediate method of treatment for progressive EOS. It can stabilize relatively large curves until the child reaches a more suitable age or size to change to other methods of treatment such as an orthosis or growing rod surgery. Patients who failed bracing at an earlier age may now find it to be effective. Risser casts were well tolerated by the patients and their families and there were minimal minor complications.

© 2010 Lippincott Williams & Wilkins, Inc.

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