Initial Cast Correction as a Predictor of Treatment Outcome Success for Infantile Idiopathic Scoliosis

Jaime A. Gomez, Alexandra Grzywna, Patricia E. Miller, Lawrence I. Karlin, Sumeet Garg, James O. Sanders, Peter F. Sturm, Paul D. Sponseller, Jacques L. D'Astous, Michael P. Glotzbecker

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Cast treatment for infantile idiopathic scoliosis patients ultimately corrects deformity in varying amounts. As the reasons for these differential outcomes are not fully elucidated, the aim of this study was to identify clinical and radiographic variables correlated with better cast correction. Methods: Patients in the Children's Spine Study Group and Growing Spine Study Group registries who underwent cast treatment for idiopathic scoliosis between 2005 and 2013 with 1-year minimum follow-up were included. Data including major curve and rib-vertebra angle difference before cast, initial in-cast application, after cast treatment, and at most recent follow-up were collected. Univariable and multivariable regression analyses were used to identify factors associated with lower major curves at most recent follow-up. Results: A total of 68 patients were identified and followed for a mean of 2.5 (range, 1.1 to 5.4) years after cast treatment. Cast treatment lasted an average of 16.7 months, with a median of 6 cast applications (range, 2 to 19). Twenty-five subjects (37%) had a most recent major curve <15 degrees (success), whereas 43 had a curve that was >15 degrees (unresolved). Multivariable linear regression determined that younger age (P=0.02), smaller precast major curve (P<0.001), and greater percent major curve correction in initial cast (P=0.006) were associated with smaller major curve at most recent follow-up. Multivariable logistic regression determined that success patients were younger than unresolved patients (average age, 1.4 vs. 2.1 y; P=0.003), and had smaller in-cast major curves after initial cast application (average, 18 vs. 27 degrees; P=0.002). Conclusions: Infantile idiopathic scoliosis patients casted at an earlier age, with smaller major curves, and greater percent major curve correction in initial cast have the best prognosis. Patients' percent major curve correction, which may represent curve flexibility and/or cast quality, is a predictor of treatment success when age and precast major curve are also taken into account. Level of Evidence: Level III - retrospective study.

Original languageEnglish (US)
Pages (from-to)e625-e630
JournalJournal of Pediatric Orthopaedics
Volume37
Issue number8
DOIs
StatePublished - Jan 1 2017

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Scoliosis
Spine
Therapeutics
Ribs
Registries
Linear Models
Retrospective Studies
Logistic Models
Regression Analysis

Keywords

  • casting
  • casts
  • early-onset scoliosis
  • elongation-derotation-flexion
  • Mehta
  • ribs
  • scoliosis
  • spine
  • treatment outcome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Initial Cast Correction as a Predictor of Treatment Outcome Success for Infantile Idiopathic Scoliosis. / Gomez, Jaime A.; Grzywna, Alexandra; Miller, Patricia E.; Karlin, Lawrence I.; Garg, Sumeet; Sanders, James O.; Sturm, Peter F.; Sponseller, Paul D.; D'Astous, Jacques L.; Glotzbecker, Michael P.

In: Journal of Pediatric Orthopaedics, Vol. 37, No. 8, 01.01.2017, p. e625-e630.

Research output: Contribution to journalArticle

Gomez, JA, Grzywna, A, Miller, PE, Karlin, LI, Garg, S, Sanders, JO, Sturm, PF, Sponseller, PD, D'Astous, JL & Glotzbecker, MP 2017, 'Initial Cast Correction as a Predictor of Treatment Outcome Success for Infantile Idiopathic Scoliosis', Journal of Pediatric Orthopaedics, vol. 37, no. 8, pp. e625-e630. https://doi.org/10.1097/BPO.0000000000001006
Gomez, Jaime A. ; Grzywna, Alexandra ; Miller, Patricia E. ; Karlin, Lawrence I. ; Garg, Sumeet ; Sanders, James O. ; Sturm, Peter F. ; Sponseller, Paul D. ; D'Astous, Jacques L. ; Glotzbecker, Michael P. / Initial Cast Correction as a Predictor of Treatment Outcome Success for Infantile Idiopathic Scoliosis. In: Journal of Pediatric Orthopaedics. 2017 ; Vol. 37, No. 8. pp. e625-e630.
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abstract = "Background: Cast treatment for infantile idiopathic scoliosis patients ultimately corrects deformity in varying amounts. As the reasons for these differential outcomes are not fully elucidated, the aim of this study was to identify clinical and radiographic variables correlated with better cast correction. Methods: Patients in the Children's Spine Study Group and Growing Spine Study Group registries who underwent cast treatment for idiopathic scoliosis between 2005 and 2013 with 1-year minimum follow-up were included. Data including major curve and rib-vertebra angle difference before cast, initial in-cast application, after cast treatment, and at most recent follow-up were collected. Univariable and multivariable regression analyses were used to identify factors associated with lower major curves at most recent follow-up. Results: A total of 68 patients were identified and followed for a mean of 2.5 (range, 1.1 to 5.4) years after cast treatment. Cast treatment lasted an average of 16.7 months, with a median of 6 cast applications (range, 2 to 19). Twenty-five subjects (37{\%}) had a most recent major curve <15 degrees (success), whereas 43 had a curve that was >15 degrees (unresolved). Multivariable linear regression determined that younger age (P=0.02), smaller precast major curve (P<0.001), and greater percent major curve correction in initial cast (P=0.006) were associated with smaller major curve at most recent follow-up. Multivariable logistic regression determined that success patients were younger than unresolved patients (average age, 1.4 vs. 2.1 y; P=0.003), and had smaller in-cast major curves after initial cast application (average, 18 vs. 27 degrees; P=0.002). Conclusions: Infantile idiopathic scoliosis patients casted at an earlier age, with smaller major curves, and greater percent major curve correction in initial cast have the best prognosis. Patients' percent major curve correction, which may represent curve flexibility and/or cast quality, is a predictor of treatment success when age and precast major curve are also taken into account. Level of Evidence: Level III - retrospective study.",
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AU - Gomez, Jaime A.

AU - Grzywna, Alexandra

AU - Miller, Patricia E.

AU - Karlin, Lawrence I.

AU - Garg, Sumeet

AU - Sanders, James O.

AU - Sturm, Peter F.

AU - Sponseller, Paul D.

AU - D'Astous, Jacques L.

AU - Glotzbecker, Michael P.

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N2 - Background: Cast treatment for infantile idiopathic scoliosis patients ultimately corrects deformity in varying amounts. As the reasons for these differential outcomes are not fully elucidated, the aim of this study was to identify clinical and radiographic variables correlated with better cast correction. Methods: Patients in the Children's Spine Study Group and Growing Spine Study Group registries who underwent cast treatment for idiopathic scoliosis between 2005 and 2013 with 1-year minimum follow-up were included. Data including major curve and rib-vertebra angle difference before cast, initial in-cast application, after cast treatment, and at most recent follow-up were collected. Univariable and multivariable regression analyses were used to identify factors associated with lower major curves at most recent follow-up. Results: A total of 68 patients were identified and followed for a mean of 2.5 (range, 1.1 to 5.4) years after cast treatment. Cast treatment lasted an average of 16.7 months, with a median of 6 cast applications (range, 2 to 19). Twenty-five subjects (37%) had a most recent major curve <15 degrees (success), whereas 43 had a curve that was >15 degrees (unresolved). Multivariable linear regression determined that younger age (P=0.02), smaller precast major curve (P<0.001), and greater percent major curve correction in initial cast (P=0.006) were associated with smaller major curve at most recent follow-up. Multivariable logistic regression determined that success patients were younger than unresolved patients (average age, 1.4 vs. 2.1 y; P=0.003), and had smaller in-cast major curves after initial cast application (average, 18 vs. 27 degrees; P=0.002). Conclusions: Infantile idiopathic scoliosis patients casted at an earlier age, with smaller major curves, and greater percent major curve correction in initial cast have the best prognosis. Patients' percent major curve correction, which may represent curve flexibility and/or cast quality, is a predictor of treatment success when age and precast major curve are also taken into account. Level of Evidence: Level III - retrospective study.

AB - Background: Cast treatment for infantile idiopathic scoliosis patients ultimately corrects deformity in varying amounts. As the reasons for these differential outcomes are not fully elucidated, the aim of this study was to identify clinical and radiographic variables correlated with better cast correction. Methods: Patients in the Children's Spine Study Group and Growing Spine Study Group registries who underwent cast treatment for idiopathic scoliosis between 2005 and 2013 with 1-year minimum follow-up were included. Data including major curve and rib-vertebra angle difference before cast, initial in-cast application, after cast treatment, and at most recent follow-up were collected. Univariable and multivariable regression analyses were used to identify factors associated with lower major curves at most recent follow-up. Results: A total of 68 patients were identified and followed for a mean of 2.5 (range, 1.1 to 5.4) years after cast treatment. Cast treatment lasted an average of 16.7 months, with a median of 6 cast applications (range, 2 to 19). Twenty-five subjects (37%) had a most recent major curve <15 degrees (success), whereas 43 had a curve that was >15 degrees (unresolved). Multivariable linear regression determined that younger age (P=0.02), smaller precast major curve (P<0.001), and greater percent major curve correction in initial cast (P=0.006) were associated with smaller major curve at most recent follow-up. Multivariable logistic regression determined that success patients were younger than unresolved patients (average age, 1.4 vs. 2.1 y; P=0.003), and had smaller in-cast major curves after initial cast application (average, 18 vs. 27 degrees; P=0.002). Conclusions: Infantile idiopathic scoliosis patients casted at an earlier age, with smaller major curves, and greater percent major curve correction in initial cast have the best prognosis. Patients' percent major curve correction, which may represent curve flexibility and/or cast quality, is a predictor of treatment success when age and precast major curve are also taken into account. Level of Evidence: Level III - retrospective study.

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KW - casts

KW - early-onset scoliosis

KW - elongation-derotation-flexion

KW - Mehta

KW - ribs

KW - scoliosis

KW - spine

KW - treatment outcome

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