Contemporary Pediatrics - March 2010 - (Page 10)
YOUR VOICE W R I T E U S AT C P L E T T E R S A D VA N S TA R . CO M Casting in scoliosis s a pediatrician and mother of a child with severe scoliosis (100-degree curve requiring surgery), I can say with great certainty that I have learned more about scoliosis treatment as the mother of a child with scoliosis than I did in my 3 years of residency. Fortunately, there are more treatment options available to children who have remaining growth (ie, VEPTR, growing rods) than when I was a resident 15 years ago, and it was a great service to provide this information to general pediatricians in the scoliosis cover article in your January issue. I do wish the authors would have expanded on casting for young children—those with infantile scoliosis who present before age 2 with scoliosis. The Early Treatment Program for young children with infantile scoliosis focuses on those children younger than 2 years who could benefit from the Mehta casting method, a method introduced at a few centers in the United States by the British orthopedic surgeon Dr Min Mehta. This treatment program channels THE AUTHORS RESPOND: Thank you for your comments regarding our recent article on scoliosis, especially given your own personal history having a child with early onset scoliosis (EOS). Our goal was to provide information to pediatricians about the new treatment options you mention, such as growing rods and the VEPTR device, so as to enhance their understanding of what their patients with scoliosis are experiencing. the rapid growth of early childhood and, together with a series of properly applied corrective plaster jackets, actually reverses the scoliotic curves in some of these young patients. As a mother who has met many families with young children with infantile scoliosis whose lives have been forever changed by scoliosis because of often ineffective bracing followed by numerous surgeries to lengthen growing rods or VEPTR rods, I have seen firsthand the emotional suffering and despair that come with scoliosis treatment in children who present at a young age. Families of children with infantile scoliosis deserve the opportunity to explore the option of serial casting, and educating their pediatricians about the availability of this method and where it can be sought is important. Each and every parent I have spoken with whose child has had to face scoliosis surgery after “watchful waiting” or ineffective bracing wishes they had had an opportunity such as early casting to explore, especially because, as the article reads, “…in Casting of young children to manage scoliosis is not new but has enjoyed a resurgence of interest in these patients with EOS. There are relatively few centers doing the casting because of the relative paucity of centers with the appropriate cast tables. The word “cure” must be used very cautiously regarding EOS. Although infantile scoliosis can resolve spontaneously, it may recur at some point prior to skeletal maturity. some instances, curve correction may also be achieved.” Of course, pediatricians refer their patients to pediatric spine surgeons for evaluation and treatment once scoliosis has been detected, and the surgeons take over treatment from there. Because of this, I think it is important for pediatricians to be aware of this treatment modality so they can present it to the families as an option for this group of patients so they can pursue a discussion with their surgeons and/or seek a second opinion with the surgeons that are, indeed, trained in this special casting. If we can potentially cure, why not give it a try? For additional information, please see these resources: • www. infantilescoliosis.org • Mehta M. Growth as a corrective force in the early treatment of progressive infantile scoliosis. J Bone Joint Surg Br. 2005;87(9):1237-1247. • D’Astous JL, Sanders JO. Casting and traction treatment methods for scoliosis. Orthop Clin North Am. 2007;38(4):477-484. KAREN ZORRILLA, MD Houston, Texas A recent study of 16 patients with EOS undergoing casting found that the majority were either in a brace, had growing rods, or were still being casted at an average follow-up of 18 months. Although no one in this series had been cured, casting is still a very useful tool in the management of these patients. –BRIAN G SMITH, MD New Haven, Connecticut C O N T E M P O R A R Y P E D I AT R I C S MARCH 2010 VOL. 27 NO. 3
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