Casting for Scoliosis

When a young child has scoliosis, a cast is an effective technique for correcting the spinal curvature and preventing it from worsening as they grow. Casting is a commonly used treatment for infants and toddlers who develop scoliosis due to congenital, neurological or unknown (idiopathic) causes.

If you are born with scoliosis or your doctor thinks your spinal curvature might get worse, you will have a plaster cast made for your body. Similar to when you make a plaster sculpture in art class, this cast is made to wrap around your body and be worn all the time.
Pediatric Orthopedic doctor

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What is Scoliosis Casting

Children ages one to four years who have a flexible spinal curvature measuring more than 35 degrees are good candidates for scoliosis casting. Due to their age and size, most children are not candidates for spinal fusion surgery because they will continue to grow and need time for their bones and organs to mature. Casting allows an orthopedic surgeon to slow the rate at which a spinal curvature progresses and, in some cases, correct or even cure a child of scoliosis.

Scoliosis casting involves a series of plaster casts applied to your child at regular intervals, typically every eight to 16 weeks, depending on your child’s age and growth until the spinal curvature halts or improves. Casting is continued until the curve progression stabilizes, improves or, in some cases, until the child is old enough for surgery. Scoliosis casting can be a gentle and effective method to align a young child’s spine and help it grow as straight as possible.

There are several types of casting methods your doctor might use depending on your child’s condition. These types include:

Mehta casting. Typically used in children less than 2 years old with congenital or early onset scoliosis. These casts apply gentle pressure to slowly straighten your child’s spine as they grow. This method can sometimes help children avoid surgery later in life.
Risser casting. Typically used in children under 4 years old. This cast prevents the progression of scoliosis as your child grows old enough for other treatments.
Serial casting. This method is called serial casting because the position of the body changes each time a new cast is applied. This gradually increases the flexibility of the muscle over time.

When left untreated, infantile scoliosis can become so severe that it limits important body systems, such as heart and lung function. Interventions such as casting – and later, bracing – help realign a curvature or manage scoliosis until a child is ready for other corrective treatment, such as surgery.

How Does Scoliosis Casting Work

Scoliosis casting is performed in an operating room with your child placed under anesthesia. While no incisions are made during the procedure, the child needs to be asleep so the orthopedic surgeon can correctly position the spine and apply the cast.

Once your child is asleep, he or she will be transferred to a special traction table made specifically for this procedure. The traction gently cradles your child in a head halter and secures the pelvis with hip straps. Traction placed through the spine allows the doctor to elongate, de-rotate and flex your child’s spine into improved alignment. This position is held while the cast hardens to your child’s body shape. Often, an x-ray is taken during the procedure to take measurements and document the corrected alignment of the scoliosis curvature.

After this procedure:

Your child will emerge from the operating room wearing the new cast.
Once your child is awake and moving after surgery, the cast may need to be further trimmed and customized for comfort and to ensure good range of motion for the arms and legs. At this point, your child can decorate the cast and may have the option to choose a pattern or color for the cast tape.
Typically, casts are worn anywhere from two to six months, depending on your child’s age and rate of growth.

How is the Cast Worn

Scoliosis casts are worn 24/7 and cannot get wet. The cast is removed by your child’s doctor to assess progress and place the next cast or brace. It's important to remember that:

Children do not shower, take baths or swim in a cast because it must stay dry. Instead, give your child a sponge bath, and wash your child’s hair in the sink or use a rinse-free shampoo.
The first layer of a cast typically is a special t-shirt that can be changed and washed.
The cast itself consists of a cotton liner and soft padding underneath a fiberglass exterior shell, which is often decorated with tape.

After your child’s final cast is removed, he or she may be placed into a removable back brace. Depending on the severity of your child’s scoliosis, bracing can be used to maintain the correction obtained with casting, continue to control curvature progression or keep it from worsening until your child is old enough to undergo corrective spinal surgery.

Key Points to Remember

Because spinal fusion surgery is not an option for infants and very young children with scoliosis, casting offers a safe and effective option to control the progression of a young child’s spinal curvature.
Casting may be a necessary treatment for progressive infantile curvatures. When left untreated, infantile scoliosis can worsen to the point of reducing a child’s life expectancy by limiting chest capacity.
Overall, children tolerate casting well and become quite comfortable wearing the cast.