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A report of two conservative approaches to early onset scoliosis: serial casting and bracing

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Abstract

Purpose

Previous reports have demonstrated the effectiveness of casting for EOS. Brace treatment for EOS has not been studied. The purpose of this multicenter retrospective study was to compare radiographic outcomes, complications, and rates of conversion to surgery in children with EOS treated with casting or bracing.

Methods

Children aged 2–6 years with idiopathic or neuromuscular EOS treated with casting or bracing with minimum follow-up of 2 years were identified.

Results

68 patients (36 cast, 32 brace) were analyzed. Diagnosis, age at start of treatment, and duration of follow-up were similar. Although the cast patients had a larger pre-treatment major curve magnitude (50° vs 31°, p < 0.001), both groups had a similar major curve magnitude at most recent follow-up (36° vs 32°, p = 0.456). T1–T12 and T1–S1 length increased in both groups. The cast and brace patients had similar complications and conversions to surgery. Sub-analysis showed that while casting resulted in curve improvement regardless of etiology, bracing was able to prevent curve progression in patients with idiopathic EOS but not in patients with non-idiopathic EOS (Δ− 15° vs 27°, p = 0.006). Regression analysis (significance p = 0.10) controlling for baseline age, major curve magnitude, and T1–T12 and T1–S1 length showed that treatment method was associated with difference in major curve magnitude (p = 0.090) and T1–T12 length (p = 0.024).

Conclusion

In our study, serial casting led to curve improvement in children with idiopathic and neuromuscular EOS, whereas brace treatment appeared to prevent curve progression in patients with idiopathic EOS but did not appear to control the curve in neuromuscular EOS.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Dr. Li has received a research grant and non-financial support from the Scoliosis Research Society. Dr. Thompson has received personal fees from Shriners Hospitals for Children and Wolters Kluwer, personal fees and royalties from OrthoPediatrics, and non-financial support from NuVasive and the Scoliosis Research Society. Dr. Sturm has received personal fees from Depuy Synthes/Johnson and Johnson and NuVasive, and is a shareholder of Green Sun Medical. Dr. Emans has received personal fees from Depuy Synthes/Johnson and Johnson and Zimmer Biomet. Dr. Sponseller has received a grant from Depuy Synthes/Johnson and Johnson, and reports other relationships with Depuy Synthes/Johnson and Johnson, Globus, OrthoPediatrics, and Journal of Bone and Joint Surgery. Dr. Glotzbecker has received personal fees and non-financial support from Medtronic, Depuy Synthes/Johnson and Johnson, Zimmer Biomet, NuVasive, and Orthobullets. The Pediatric Spine Study Group has received research grants from the Pediatric Orthopaedic Society of North America, Food and Drug Administration, Depuy Synthes/Johnson and Johnson, NuVasive, Children’s Spine Foundation, and Growing Spine Foundation. The remaining authors declare that they have no conflicts of interest.

Funding

The study was funded by departmental resources.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, C.S. Mott Children’s Hospital, Michigan Medicine, 1540 E. Hospital Dr., SPC 4241, Ann Arbor, MI, 48109-4241, USA

    Ying Li, Jennylee Swallow & Joel Gagnier

  2. Department of Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA

    George H. Thompson & Michael P. Glotzbecker

  3. Department of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Peter F. Sturm

  4. Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA

    John B. Emans

  5. Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA

    Paul D. Sponseller

Authors
  1. Ying Li
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  2. Jennylee Swallow
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  3. Joel Gagnier
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  4. George H. Thompson
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  5. Peter F. Sturm
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  6. John B. Emans
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  7. Paul D. Sponseller
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  8. Michael P. Glotzbecker
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Consortia

Pediatric Spine Study Group

Contributions

YL: made substantial contributions to the conception or design of the work, and performed analysis and interpretation of data; drafted the work; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JS: performed acquisition of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JG: performed data analysis; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GHT: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PFS: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JBE: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PDS: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MPG: made substantial contributions to the conception or design of the work and performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Pediatric Spine Study Group: performed acquisition of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Ying Li.

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Conflict of interest

Dr. Li has received a research grant and non-financial support from the Scoliosis Research Society. Dr. Thompson has received personal fees from Shriners Hospitals for Children and Wolters Kluwer, personal fees and royalties from OrthoPediatrics, and non-financial support from NuVasive and the Scoliosis Research Society. Dr. Sturm has received personal fees from Depuy Synthes/Johnson and Johnson and NuVasive, and is a shareholder of Green Sun Medical. Dr. Emans has received personal fees from Depuy Synthes/Johnson and Johnson and Zimmer Biomet. Dr. Sponseller has received a grant from Depuy Synthes/Johnson and Johnson, and reports other relationships with Depuy Synthes/Johnson and Johnson, Globus, OrthoPediatrics, and Journal of Bone and Joint Surgery. Dr. Glotzbecker has received personal fees and non-financial support from Medtronic, Depuy Synthes/Johnson and Johnson, Zimmer Biomet, NuVasive, and Orthobullets. The Pediatric Spine Study Group has received research grants from the Pediatric Orthopaedic Society of North America, Food and Drug Administration, Depuy Synthes/Johnson and Johnson, NuVasive, Children’s Spine Foundation, and Growing Spine Foundation. The remaining authors declare that they have no conflicts of interest.

Ethics approval

IRB approval, University of Michigan, HUM 00082789, 1/7/14.

Consent to participate

Informed consent to participate in this study was obtained from the parent or legal guardian of all participants.

Consent for publication

Not applicable.

Code availability

The software application and code used for the statistical analysis are available from the corresponding author on reasonable request.

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Li, Y., Swallow, J., Gagnier, J. et al. A report of two conservative approaches to early onset scoliosis: serial casting and bracing. Spine Deform 9, 595–602 (2021). https://doi.org/10.1007/s43390-020-00213-2

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  • DOI: https://doi.org/10.1007/s43390-020-00213-2

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