Scoliosis Research Society (SRS)
An International Organization Dedicated to the Education, Research and Treatment of Spinal Deformity
Our Mission is to Foster Optimal Care for All Patients with Spinal Deformities
A few centers treat young children with a body cast (Figure 5). Placement of the cast on the child may require general anesthesia to increase flexibility of the curve and make the child more comfortable during the application. The cast is generally changed every two to four months, usually under an anesthetic. Casting can offer superior curve management, at the cost of its inconvenience (cannot be removed for bathing).
Serial casting (one cast after another, changing at regular intervals to allow for growth) can be used to delay the need for bracing by correcting the deformity enough to allow bracing to then be re-instituted. Since a cast can be considered a full-time brace that can't be removed, many parents find it preferable to braces, eliminating the problems of compliance and the difficulties of donning braces in uncooperative young children.
Casting can become a definitive method of management rather than simply a delay tactic. Research in the United Kingdom indicates that treating non-congenital scoliosis with serial casts beginning in children at 12 months of age with an average curve of 32° in some cases have their scoliosis reduced to up to <10° at maturity. Patients starting treatment at 18 months or later, with larger curves averaging 52°, achieve less correction, but their deformities can be maintained at a similar degree of magnitude.
Casting in children under 2 years of age, where the goal is curing the scoliosis, requires cast changes under anesthesia every 2-3 months (minimum 5 casts) with the goal of achieving a straight spine. Despite the extensive casting a brace will still be needed after the casting treatment. Children over age 2 require cast changes every 3-4 months. Older children demonstrating "recurrence" can be re-casted for four months to re-correct the deformity before continuing with brace management.
Figure 5 - Patients treated with scoliosis casting. Holes are cut along the chest and abdomen to allow for normal breathing and eating. Shoulder straps are optional.