What is Scoliosis Casting?

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Scoliosis Casting in Young Children: A Non-Surgical Approach to Early-Onset Scoliosis

Scoliosis (sko-lee-OH-sis) is an abnormal curvature of the spine. When viewed from behind, a child’s spine may show a noticeable curve or curves. In children younger than 10 years old, this condition is referred to as Early-Onset Scoliosis (EOS). Left untreated, scoliosis can worsen, impacting chest growth, lung development, and overall spinal function.

For very young children, scoliosis casting is often the first line of treatment, aiming to slow or correct spinal curvature while allowing the child to continue growing naturally.

Why Casting Is Important for Young Children

Children under 2–4 years old are usually not candidates for spinal fusion surgery because their bones and organs are still developing. Casting allows orthopedic specialists to:

  • Slow curve progression
  • Correct spinal deformity in some cases
  • Avoid or delay surgery until the child is older

Serial casting leverages the growing spine’s natural ability to remodel and align over time. This is especially effective for flexible curves less than 60° and when treatment starts at a very young age.

Types of Scoliosis Casting

1. Mehta Casting

  • Typically for children under 2 years old.
  • Applies gentle, consistent pressure to gradually straighten the spine.
  • The cast extends from the hips to just below the armpits, with an abdominal opening to allow for belly expansion.
  • Cast is replaced every 4–8 weeks in a process called serial Mehta casting, continued until enough spinal correction is achieved or it’s time to transition to a brace.

2. Risser Casting

  • Usually for children under 4 years old.
  • Prevents progression until the child is ready for other treatments.

3. Serial Casting

  • Each cast is applied in a slightly modified position to gradually improve spinal flexibility.
  • Often uses EDF (Elongation-Derotation-Flexion) technique to optimize correction.

How Scoliosis Casting Works

In the Hospital

  • The procedure is usually outpatient and requires general anesthesia.
  • Child is placed on a special traction table to position the spine:
    • Head held in a halter
    • Pelvis secured with straps
    • Traction elongates, rotates, and flexes the spine
  • The cast is molded while the child is asleep to ensure correct alignment.
  • X-rays may be taken during the procedure to monitor progress.
  • Cast materials may include cotton with fiberglass or waterproof synthetic materials.
  • Soft padding or moleskin “petals” are added to prevent skin irritation at the edges.

Duration: Casting procedures usually take about one hour.

At Home: Cast Care

Cotton Casts

  • Must stay clean and dry
  • Sponge baths only; hair can be washed with rinse-free shampoo
  • Replace moleskin petals as needed to prevent skin breakdown

Waterproof Casts

  • Can get wet during bathing
  • Soap residue must be rinsed thoroughly
  • Use a hair dryer on cool to dry skin

Other Tips

  • Write on the cast only with water-based markers
  • Avoid letting objects enter the cast
  • Monitor the child to prevent dirt, rocks, or small objects from causing irritation

Managing Itching and Skin Health

  • Gently tap or knock on the cast
  • Use a hair dryer on cool setting for 1–2 minutes
  • Ask the doctor about antihistamines (Benadryl® or Claritin®)
  • Do not insert objects into the cast
  • Keep the child out of direct sunlight

Pressure Injuries

  • Check for redness, sores, or discomfort daily
  • Encourage frequent position changes
  • Contact the orthopedic office if skin changes do not improve

Food, Diet, and Activity

  • Small, frequent meals may be more comfortable
  • Encourage hydration to prevent constipation
  • Avoid high-risk activities (trampolines, climbing)

EDF (Elongation-Derotation-Flexion) Casting Technique

  • Utilizes three corrective forces: elongation, derotation, and flexion
  • Applied using the Cotrel-Mehta frame
  • Allows for optimal spinal alignment while the child grows
  • Can be done awake or under anesthesia, though GA improves precision

Follow-Up: Casts are replaced every 2–3 months based on growth and spinal curve progression.

Benefits of Scoliosis Casting

  • Halts or slows spinal curve progression
  • Can lead to partial or complete correction in some cases
  • Improves lung development by allowing proper chest growth
  • Reduces the need for early surgical intervention

When Surgery May Be Needed

  • Cobb angle >50° or rapidly progressing curve
  • Non-surgical treatment fails to control progression
  • Casting primarily delays surgery, giving time for growth

Common Concerns and Complications

  • Mild skin irritation, rashes, or blisters
  • Temporary stiffness or muscle weakness
  • Rare: subclavian vein thrombosis or chest pressure during cast hardening
  • Repeated anesthesia may have potential neurocognitive effects, though alternatives are being studied

Bracing During or After Casting

  • Braces may be used as a supplement after casting
  • Alone, braces may be less effective in very young children

Follow-Up and Monitoring

  • Regular orthopedic visits for cast assessment
  • Skin checks and moleskin adjustments
  • Plan for next cast change or transition to brace

When to Call the Orthopedic Office

  • Pressure injuries or skin breakdown
  • Objects stuck inside the cast
  • Foul odor or cast getting too tight or broken
  • Changes in skin color, movement, or sensation
  • Persistent pain or fever

Conclusion

Scoliosis casting is a safe and effective early intervention for young children with early-onset scoliosis. It provides a non-surgical method to control curve progression, correct spinal deformities, and improve overall quality of life. With proper care, serial casting can help many children avoid or delay surgery while their spine and chest develop normally

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