Effectiveness of serial EDF casting for children with infantile and juvenile scoliosis

Description

INTRODUCTION: The ideal treatment of infantile and juvenile scoliosis has not yet been found. Elongation, derotation, flexion (EDF) casting technique is a custom-made thoracolumbar cast based on a three-dimensional correction concept. Spinal growth can be guided by EDF casting as it can influence the initially curved spine to grow straighter. The EDF cast provides three-dimensional correction of the deformity, controls the evolution of the deformity in some cases, and it allows the patient to grow enough to better tolerate other forms of treatment, such as growing devices. EVIDENCE ACQUISITION: We searched the Medline and EMBASE databases from January 1955 to September 2020 for articles using the following search terms: "early onset scoliosis," "infantile scoliosis," "juvenile scoliosis," "congenital scoliosis," "serial casting," "EDF casting," "Metha casting" and "children." We used limits of "English language" and "all children 0-10." EVIDENCE SYNTHESIS : Serial EDF casting should be considered a valuable low risk treatment modality, as well as an alternative to surgery, for patients with infantile and juvenile scoliosis. Serial casting is constantly associated with a reduction in the mean Cobb angle, and the most common adverse events were reversible skin irritation and transient pulmonary symptoms. All authors agree casting is effective and safe in decreasing Cobb angle even in high curve magnitude, while in older patients the technique showed less Cobb angle correction; however, published research is extremely heterogeneous and level of evidence of published studies is mostly low (only one level II and five level III studies; all others are level IV and expert opinions). CONCLUSIONS: Infantile and juvenile scoliosis are a challenge for pediatric orthopedic surgeons as preservation of the thoracic spine, thoracic cage, lung and cardiac function and growth without reducing spinal motion must be considered simultaneously. ED F casting is a safe technique that can modify the natural evolution of the infantile and juvenile-type scoliosis by reducing and slowing curve progression in both frontal and transverse plane.

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