Lateral Suspension Bending Casting in the Treatment of Early-onset Scoliosis.

Abstract

Early-onset scoliosis (EOS) presents significant challenges due to its potential to progress and cause pulmonary complications, necessitating early and effective intervention. Historically, casting techniques have evolved to address these deformities, with elongation-derotation-flexion (EDF) casting being the predominant method. However, EDF casting requires specialized equipment and can be time-consuming. This paper introduces an alternative method for addressing sweeping thoracolumbar curves in EOS: the three-point lateral suspension bending cast. This technique offers several advantages over EDF casting, including ease of application without specialized equipment, reduced procedural time, and the use of waterproof materials. The method involves positioning the patient with the convex apex side of the curve down, using a muslin bias wrap to create a bending fulcrum, and applying a cast that maintains a three-point bending force. This technique is particularly advantageous in settings where access to specialized equipment is limited or in patients with airway considerations. While effective in treating single sweeping curves, challenges remain in applying this method to double curves or thoracic apices above T9. Despite its longstanding use in a high-volume pediatric spine center, this method has not been extensively documented in the literature. The described technique provides a viable, cost-effective alternative for EOS management, with potential implications for broader application in diverse healthcare settings.

Key concepts: (1)Lateral suspension bending casting is an alternative method to elongation-derotation-flexion casting for achieving correction in early-onset scoliosis(2)Bending casts may be applied with minimal specialized equipment and without traction to the neck and head, making it an attractive option for patients with tenuous airways or in environments without a Cotrel table.(3)Bending casts may be applied with waterproof material, for improved patient hygiene and caregiver satisfaction.(4)This method of casting is ideal in long, sweeping thoracolumbar curves with an apex below T8.