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Serial Derotational Casting in Congenital Scoliosis as a Time-buying Strategy

Demirkiran, Halil G. MD; Bekmez, Senol MD; Celilov, Rustem MD; Ayvaz, Mehmet MD; Dede, Ozgur MD; Yazici, Muharrem MD

Journal of Pediatric Orthopaedics: January 2015 - Volume 35 - Issue 1 - p 43–49
doi: 10.1097/BPO.0000000000000229
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Background: Serial casting is an effective treatment modality in early-onset idiopathic scoliosis; however, the role of this method in congenital scoliosis is not well studied.

Methods: A total of 11 patients with progressive congenital scoliosis were treated with serial cast application. Age at initial cast application, magnitudes of the congenital, compensatory and sagittal deformities, coronal balance, T1 to T12 height, number of casts and time-in cast per patient, subsequent surgical interventions, and complications were evaluated.

Results: Mean age at the first cast application was 40 months, and the average number of cast changes was 6.2 per patient. There were no major complications. The average precasting curve magnitude was 70.7 degrees (range, 44 to 88 degrees) and was significantly reduced to 55.1 degrees (range, 16 to 78 degrees) at the latest follow-up (P=0.005). The average precasting compensatory curve was 55.8 degrees (range, 38 to 72 degrees) and was significantly reduced to 39.8 degrees (range, 23 to 62 degrees) at the latest follow-up (P=0.017). Average T1 to 12 height increased from 12.8 cm at post-first cast to a 14.6 cm at the latest follow-up (P=0.04). Average time in cast was 26.3 months (range, 13 to 49 mo). During the treatment period, none of the patients required surgery for curve progression.

Conclusions: Serial derotational casting is a safe and effective time-buying strategy to delay the surgical interventions in congenital deformities in the short-term follow-up.

Level of Evidence: Level IV, case series.

*Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine

Department of Orthopaedics and Traumatology, Dr Sami Ulus Children’s Hospital, Ankara, Turkey

Department of Orthopaedic Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA

The authors declare no conflicts of interest.

Reprints: Muharrem Yazici, MD, Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, 06100 Sihhiye, Ankara, Turkey. E-mail: mimyazici@gmail.com.

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