Infantile Scoliosis
Casting

If the curve is progressive, serial casting (Figure 4) can be used to partially correct the deformity before beginning bracing. A cast can be considered a full-time brace which cannot be removed. Many parents prefer casting because it eliminates the problems of compliance and the difficulties of donning braces in uncooperative young children.

Casting can become a definitive method of management. 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.

The goal of casting in children under 2 years of age is curing the scoliosis. This 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. Older children demonstrating "recurrence" can be re-casted for four months to re-correct the deformity before continuing with brace management.

Figure 4: Front and back views of a child in a cast for scoliosis.