Minimum 5-Year Follow-Up Of Mehta Casting To Treat Idiopathic Early-Onset Scoliosis

Background: With the exception of Mehta's 2005 report on her experience treating early-onset scoliosis with serial casting, all subsequent studies have had limited follow-up. This current study sought to assess the results of serial casting at a minimum 5-year follow-up and to identify the predictors of the sustained resolution of scoliosis.Methods: This study is a retrospective review of children treated for idiopathic early-onset scoliosis with serial casting at a children's hospital between 2001 and 2013 with a minimum 5-year follow-up. A Cobb angle of <= 15 degrees and a decrease in the Cobb angle of >20 degrees at the most recent follow-up were separately assessed. The differences between groups based on these criteria were tested with Student t tests with alpha = 0.05.Results: Fifty-four children were treated during the study period; of these, 38 had at least 5 years of follow-up and comprised the study sample. The mean follow-up (and standard deviation) was 8 +/- 2 years (range, 5 to 13 years). The mean patient age at the time of the first cast was 24 +/- 15.1 months (range, 9 to 63 months), with a mean Cobb angle of 56.2 degrees +/- 20.1 degrees (range, 22 degrees to 109 degrees). Forty-nine percent of children had scoliosis of <= 15 degrees at the time of the most recent follow-up, and 73% of children were improved by at least 20 degrees. Children with <= 15 degrees scoliosis, compared with children with >15 degrees scoliosis, had significantly lower initial Cobb angle (48.2 degrees compared with 63.7 degrees; p = 0.016), supine traction Cobb angle (22.5 degrees compared with 33.2 degrees; p = 0.048), first-in-cast Cobb angle (24.1 degrees compared with 37.6 degrees; p = 0.01), and first-incast rib-vertebral angle difference (12.8 degrees compared with 26.2 degrees; p < 0.01). Age at the time of the first cast, initial rib-vertebral angle difference, flexibility, and body mass index were not significantly different (p > 0.05) between the groups. Three children who initially achieved scoliosis of <= 15 degrees after casting substantially relapsed.Conclusions: At a minimum follow-up of 5 years, the initial Cobb angle, first-cast Cobb angle, rib-vertebral angle difference, and traction Cobb angle were all predictive of sustained scoliosis of <= 15 degrees. However, with continued growth, relapse of scoliosis was seen in 3 patients.