Serial Casting for Early-Onset Scoliosis

Abstract

Background: Early-onset scoliosis (EOS) is a severe spinal deformity that can compromise thoracic development and pulmonary function if left untreated. While Mehta casting is widely used to manage deformity non-surgically in young children, its effects on spinal and thoracic growth remain underexplored. Methods: In this retrospective case series, 15 children with EOS underwent serial elongation-derotation-flexion (EDF) Mehta casting. Radiographic assessments were performed pre-treatment, post-casting, and at follow-up, including measurements of Cobb angle, rib-vertebral angle difference (RVAD), Th1-Th12 spinal length, coronal chest width (CCW), and space available for lung (SAL). Growth rates were estimated based on the duration of treatment. Correlation analyses were conducted to examine associations between baseline deformity and structural outcomes. Results: Serial casting reduced the mean Cobb angle by 22.2° and RVAD by 15.5°. During treatment, measurable increases were observed in Th1-Th12 length (mean: 2.93 cm), CCW (1.12 cm), SAL-L (2.60 cm), and SAL-R (2.98 cm). Estimated annual growth was significantly greater in children with lower initial Cobb and RVAD values. In contrast, total casting duration showed no consistent correlation with growth outcomes. Conclusions: Mehta casting is effective not only in correcting spinal deformity but also in supporting thoracic and axial growth in children with EOS. Early application in flexible, less severe curves may optimize structural outcomes and preserve thoracic development during early growth.

Keywords: casts; child; infant; orthotic devices; preschool; scoliosis; spine/growth and development; thorax/growth and development.

Figure 1

A child just after applying a cast on a frame. Still under general anesthesia. The last part of the procedure is cast trimming.

Figure 2

Measurements used in the manuscript: (a) coronal balance; (b) Th1–Th12 spinal length (the distance between first thoracic vertebra and twelve thoracic vertebra); (c) coronal chest width.

Figure 3

Measurements used in the manuscript: space available for lung (SAL) on the left (SAL-L) and right (SAL-R) hemithorax.

Figure 4

Flow diagram of patient enrollment, exclusion, and analysis.

Figure 5

Patient GM, with early onset scoliosis: (a) before treatment, age 1.5 years, Cobb angle 43°; (b) during casting, age 2 years; (c) after treatment, age 4.1, Cobb angle 17°; (d) follow up, age 7.11 years, Cobb angle 3°.