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Safety and efficacy of waterproof casting for early onset scoliosis

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Abstract

Purpose

The efficacy of traditional Mehta casting in the treatment of early onset scoliosis (EOS) is well-established. However, waterproof casting has not been previously described. Inherent advantages of waterproof casting include clearance for bathing/swimming, avoiding cast holidays, and improved family satisfaction. The purpose of this study was to assess the safety and efficacy of waterproof serial casting at controlling curve progression in EOS.

Methods

The current study is an IRB-approved Level IV retrospective consecutive cohort of EOS patients who underwent a serial 75% body weight traction-elongation-flexion Mehta cast protocol with waterproof cast padding. The addition of 3-point apical translation with stockinettes was utilized during casting. Bracing was initiated after correction < 15° or 1 year of serial casting.

Results

Seventeen patients at mean age 21.6 months, with pre-cast Cobb angle 52.3° (R: 35°–82°), underwent serial waterproof casting. In-cast correction index was 64%; for post-cast, Cobb angle was 18.6°. At mean 5.6 years follow-up (R: 2.3–8.9 years), 82% successfully avoided surgical intervention, 53% maintained correction < 25°, and 29% are considered “cured”. 3/17 (18%) underwent a 2nd round of casting, and a total of 3/17 (18%) ultimately required surgery at 6.2 years post-casting. No major cast-related complications, decubiti, or cast holidays were encountered.

Conclusion

Serial waterproof casting is safe and efficacious in EOS when compared to published results of traditional Mehta casting. Of 17 patients with mean pre-cast Cobb 52.3°, 82% successfully avoided surgery and 53% maintained mild curves < 25° magnitude at 5.6 years follow-up. No major complications or skin decubiti occurred, and advantages include clearance for bathing and avoidance of need for cast holidays during treatment.

Level of evidence

Level IV.

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Data availability

Study data available upon request to authors.

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Funding

No external funding or research grants were obtained or utilized for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Cleveland Clinic Akron General, Akron, OH, USA

    Keegan T. Conry

  2. Department of Orthopaedics, Akron Children’s Hospital, 215 West Bowery Street, Akron, OH, 44308, USA

    Lorena V. Floccari, Melanie Morscher, Miraides F. Brown & Todd F. Ritzman

Authors
  1. Keegan T. Conry
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  2. Lorena V. Floccari
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  3. Melanie Morscher
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  4. Miraides F. Brown
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  5. Todd F. Ritzman
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Contributions

Keegan Conry: made substantial contributions to conception/design or data acquisition, drafted or critically revised work, approved version to be published, agree to be accountable for all aspects of the work. Lorena Floccari: made substantial contributions to conception/design or data acquisition, drafted or critically revised work, approved version to be published, agree to be accountable for all aspects of the work. Melanie Morscher: made substantial contributions to conception/design or data acquisition, drafted or critically revised work, approved version to be published, agree to be accountable for all aspects of the work. Maraides Brown: made substantial contributions to conception/design or data acquisition, drafted or critically revised work, approved version to be published, agree to be accountable for all aspects of the work. Todd Ritzman: made substantial contributions to conception/design or data acquisition, drafted or critically revised work, approved version to be published, agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Todd F. Ritzman.

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Conry, K.T., Floccari, L.V., Morscher, M. et al. Safety and efficacy of waterproof casting for early onset scoliosis. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00868-1

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