Although corrective cast (CC) has been back in use for the treatment of early onset scoliosis (EOS), no studies have reported how clinically meaningful CC was in comparison with brace-only treatment (BT) in EOS. The aim of this study was to investigate the effect of CC treatment in terms of suppression of scoliosis progression before surgery.
This study was designed to conduct a comparison of patients treated at 2 spine institutions differing in treating methods (one: mainly CC with brace, the other: BT). Applying casts were performed without general anesthesia and repeatedly with the interval of 2 to 6 months combined with corrective brace application called alternatively repetitive cast and brace treatment (ARCBT). In total, 58 patients met the following criteria: (1) age at the first visit ≤6 years, (2) scoliosis ≥40 degrees, (3) conservative treatment≥2 years. Patients with congenital scoliosis were excluded in this study. In total, 58 patients were divided into 2 groups; cast/brace group (C/B-G) and BT group (B-G).
There were no significant differences of diagnosis (P=0.2773), sex (P=0.0670), age at the first visit (P=0.1457), scoliosis magnitude (P=0.1980), and duration for conservative treatment (P=0.2578) between 2 groups. Most of the patients who were treated with ARCBT, were switched to BT due to lower compliance for CC after the age of around 7 years. The progression of scoliosis during ARCBT and BT were 4.4 and 5.8 degree/y, respectively. Those during ARCBT in C/B-G was 2.8 degree/y comparing with 8.4 degree/y after switch to BT after 7 years of age. There was a significant difference between scoliosis progression during ARCBT in C/B-G and that of B-G (P=0.0086).
This study showed that ARCBT had a significant impact on suppression of scoliosis progression compared with BT in EOS. However, the termination of cast application and the switch to BT may be still a clinical question considering the time to surgical intervention.
Level III—retrospective comparative study.
*Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya
†Department of Orthopedic Surgery, National Kobe Medical Center, Kobe, Japan
NPO Japan Spinal Deformity Institute: Noriaki Kawakami, Izumi Koumoto, Yoshihiro Dogaki, Toshiki Saito, Ryoji Tauchi, Kazuki Kawakami, Teppei Suzuki, and Koki Uno.
The authors declare no conflicts of interest.
Reprints: Noriaki Kawakami, MD, DMSc, Department of Orthopedics and Spine Surgery, Meijo Hospital, 1-3-1 Sannomaru Naka-ku, Nagoya, Aichi prefecture 460-0001, Japan. E-mail: firstname.lastname@example.org.