Abstract
Introduction
Serial body casting plays an important role in the treatment of early onset scoliosis (EOS), serving as a safer method compared to surgical intervention. There is no published evidence documenting the impact of casting on health-related quality of life (HRQoL) of patients and their caregivers. The purpose of this study was to utilize the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) to compare the HRQoL of patients with EOS and the burden of care for their caregivers before, during, and after treatment with Mehta casting.
Methods
In this multicenter retrospective cohort study, two EOS databases were queried for patients with EOS who underwent serial casting from 2005 to 2016. Patients who had treatment prior to their initial cast application, including bracing or surgical intervention, were excluded from the study. Patients were stratified into two subgroups and analyzed separately: those with idiopathic etiology, and those with non-idiopathic etiology. HRQoL and burden of care were assessed using the EOSQ-24 completed before, during, and after cast treatment.
Results
91 patients were identified in this study (mean age at the index casting: 2.1 ± 1.2 years, mean age at final cast removal: 4.1 ± 1.3 years). 59 (64.8%) had EOS of idiopathic etiology, while 32 (35.2%) had EOS of non-idiopathic etiology, including 10 congenital, 6 neuromuscular, and 16 syndromic. Idiopathic patients and non-idiopathic patients experienced an improvement in the coronal deformity from 45° pre-cast to 26° post-cast, and from 59° pre-cast to 34° post-cast, respectively. Patients with idiopathic scoliosis experienced a decrease from baseline in nearly all EOSQ-24 sub-domain scores except for general health. Furthermore, even after the removal of the cast, patients with idiopathic etiology suffered residual negative effects of casting on emotion and transfer sub-domains. Among patients with non-idiopathic etiology, decreased scores from baseline were observed only in transfer and emotion sub-domains during the casting intervention. After brace removal, patients with non-idiopathic etiology had increased scores compared to their baseline scores in most sub-domains.
Discussion
Serial body casting can prevent curve correction in patients with EOS. However, the psychosocial stresses secondary to this non-operative intervention can have significant negative impacts on HRQoL for both idiopathic and non-idiopathic patients during the course of treatment. Although non-idiopathic patients experience improved HRQoL following treatment, idiopathic patients do not seem to exhibit much improvement in HRQoL from baseline even years after the final cast removal.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fernandes P, Weinstein SL (2007) Natural history of early onset scoliosis. J Bone Jt Surg Am 89(Suppl 1):21–33
Baulesh DM, Huh J, Judkins T, Garg S, Miller NH, Erickson MA (2012) The role of serial casting in early-onset scoliosis (EOS). J Pediatr Orthop 32:658–663. https://doi.org/10.1097/BPO.0b013e318269c438
Hassanzadeh H, Nandyala SV, Puvanesarajah V, Manning BT, Jain A, Hammerberg KW (2015) Serial Mehta cast utilization in infantile idiopathic scoliosis: evaluation of radiographic predictors. J Pediatr Orthop 00:1–5. https://doi.org/10.1097/BPO.0000000000000698
Sanders JO, D’Astous J, Fitzgerald M, Khoury JG, Kishan S, Sturm PF (2009) Derotational casting for progressive infantile scoliosis. J Pediatr Orthop 29:581–587. https://doi.org/10.1097/BPO.0b013e3181b2f8df
Mehta MH (2005) Growth as a corrective force in the early treatment of progressive infantile scoliosis. J Bone Jt Surg Br 87:1237–1247. https://doi.org/10.1302/0301-620X.87B9.16124
Matsumoto H, Williams B, Park H (2016) The Final 24-Item Early Onset Scoliosis Questionnaires. J Pediatr Orthop 38:1–8
Mehta MH (1972) The rib-vertebra angle in the early diagnosis between resolving and progressive infantile scoliosis. J Bone Jt Surg Br 54:230–243
Demirkiran HG, Bekmez S, Celilov R, Ayvaz M, Dede O, Yazici M (2015) Serial derotational casting in congenital scoliosis as a time-buying strategy. J Pediatr Orthop 35:43–49. https://doi.org/10.1097/BPO.0000000000000229
Waldron SR, Poe-Kochert C, Son-Hing JP, Thompson GH (2013) Early onset scoliosis: the value of serial risser casts. J Pediatr Orthop 33:775–780. https://doi.org/10.1097/BPO.0000000000000072
FDA Drug Safety Communication (2020) FDA approves label changes for use of general anesthetic and sedation drugs in young children | FDA, (n.d.). https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-approves-label-changes-use-general-anesthetic-and-sedation-drugs. Accessed 19 Feb 2020
FDA Drug Safety Communication (2020) FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women | FDA, (n.d.). https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-review-results-new-warnings-about-using-general-anesthetics-and. Accessed 19 Feb 2020
Fletcher ND, McClung A, Rathjen KE, Denning JR, Browne R, Johnston CE (2012) Serial casting as a delay tactic in the treatment of moderate-to-severe early-onset scoliosis. J Pediatr Orthop 32:664–671. https://doi.org/10.1097/BPO.0b013e31824bdb55
Li Y, Burke M, Robbins C, Yaszay B, Akbarnia B, Andras L, Oetgen M, G.S.S. Group (2018) Comparison of health-related quality of life in patients with early onset scoliosis treated with serial casting vs traditional growing rods. Spine Deform 6:813–814. https://doi.org/10.1016/j.jspd.2018.09.050
Acknowledgements
This work was conducted without the support of additional funding.
Funding
This study is funded by Children's Spine Foundation.
Author information
Authors and Affiliations
Consortia
Contributions
HM: conception and design, supervision, data analysis and interpretation, original manuscript writing, final approval; EA: data curation, resources, conception and design, data interpretation, visualization, original draft of the manuscirpt, revision, final approval; MWF: investigation, revision, final approval; CWH: investigation, revision, final approval; TSH: investigation, revision, final approval; BR: conception and design, supervision, final approval; PS: investigation, revision, final approval; SG: investigation, revision, final approval; JS: investigation, revision, final approval; MO: investigation, revision, final approval; SL: investigation, visualization, revision, final approval; DR: investigation, revision, final approval; MV: conception and design, supervision, final approval; Pediatric Spine Study Group: investigation, revision, final approval.
Corresponding author
Ethics declarations
IRB Approval/Research Ethics Committee
This work is approved by the Institutional Review Board at Columbia University (AAAR0061).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Matsumoto, H., Auran, E., Fields, M.W. et al. Serial casting for early onset scoliosis and its effects on health-related quality of life during and after discontinuation of treatment. Spine Deform 8, 1361–1367 (2020). https://doi.org/10.1007/s43390-020-00175-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43390-020-00175-5