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Thread: Why No Casting Option?

  1. #1
    Join Date
    Feb 2010
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    Why No Casting Option?

    My wife and I have Kaiser Insurance and have known for about a year that our daughter has scoliosis. Her doctor prescribed her to get a TLSO brace and she's been wearing it since September. That is when the curve started progressing. Since then, the curve hasn't stopped and it's now at 58 degrees.
    Just recently we found out about the mehta casting option and she's going to have it done in a week or so.

    Our question is why aren't more Hospitals/Doctor's using this technique to help infantile scoliosis (idiopathic)? Is it because of cost's? The brace is nice because it can be cleaned and removed for baths, but it doesn't seem to serve the purpose of correcting the curve. We don't understand why we weren't informed about this by our doctor. Not that it was a conspiracy or anything. Just can't believe that our doctor didn't recommend or know about it.

    Thanks,
    Nate & Kelly

  2. #2
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    Quote Originally Posted by audreymdawson View Post
    My wife and I have Kaiser Insurance and have known for about a year that our daughter has scoliosis. Her doctor prescribed her to get a TLSO brace and she's been wearing it since September. That is when the curve started progressing. Since then, the curve hasn't stopped and it's now at 58 degrees.
    Just recently we found out about the mehta casting option and she's going to have it done in a week or so.

    Our question is why aren't more Hospitals/Doctor's using this technique to help infantile scoliosis (idiopathic)? Is it because of cost's? The brace is nice because it can be cleaned and removed for baths, but it doesn't seem to serve the purpose of correcting the curve. We don't understand why we weren't informed about this by our doctor. Not that it was a conspiracy or anything. Just can't believe that our doctor didn't recommend or know about it.

    Thanks,
    Nate & Kelly
    Hi...

    Obviously, doctors may have different reasons why they do or don't recommend a specific treatment. You should question this doctor if it's important to know the answer. It seems to me that serial casting would be less expensive than bracing (at least custom bracing).

    Here's an abstract of the latest research on that topic:

    The role of bracing, casting, and vertical expandable prosthetic titanium rib for the treatment of infantile idiopathic scoliosis: a single-institution experience with 31 consecutive patients. Clinical article.

    Smith JR, Samdani AF, Pahys J, Ranade A, Asghar J, Cahill P, Betz RR.

    Shriners Hospital for Children, Philadelphia, Pennsylvania 19140, USA.

    Comment in:

    * J Neurosurg Spine. 2009 Jul;11(1):1-2; discussion 2.

    OBJECT: There are few data on treatment results for patients with idiopathic infantile scoliosis (IIS). Thus, the authors have performed a retrospective review of their experience with treating these patients, particularly as newer technologies, such as the vertical expandable prosthetic titanium rib (VEPTR), emerge. METHODS: This retrospective study was conducted to evaluate the methods of treatment used to manage IIS at a single institution. The authors reviewed 31 consecutive patients with a primary diagnosis of IIS. Patients were screened to ensure that there were no confounding congenital anomalies or comorbidities that may have contributed to the spinal deformity. The average age at the time of initial treatment was 25 months. Treatment modalities included bracing, serial body casting, and VEPTR. Pretreatment, posttreatment, and most recent Cobb angles were compared to assess the overall curve correction, and patient charts were reviewed for the occurrence of complications. RESULTS: Of the 31 patients, 17 were treated with a brace, 9 of whom had curve progression and went on to other forms of treatment. Of the 8 who did respond, there was an overall improvement of 51.2%. The 10 patients who received body casts, who had a mean preoperative Cobb angle of 50.4 degrees, demonstrated an average correction of 59.0%, with only a few skin irritations reported. The 10 patients treated with VEPTR devices demonstrated a mean preoperative Cobb angle of 90.0 degrees, and an average correction of 33.8% was attained. Three of the VEPTR-treated patients (33%) experienced minor problems. CONCLUSIONS: The authors' results suggest that body casting has utility for appropriately selected patients; that is, those with smaller, flexible spinal curves. Bracing had limited utility, with high levels of progression and the need for secondary treatments. The VEPTR device appears to be a viable alternative for large-magnitude curves.

    J Pediatr Orthop. 2009 Sep;29(6):581-7.
    Derotational casting for progressive infantile scoliosis.

    Sanders JO, D'Astous J, Fitzgerald M, Khoury JG, Kishan S, Sturm PF.

    Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY 14642, USA. James_sanders@urmc.rochester.edu

    BACKGROUND: Serial cast correction by using the Cotrel derotation technique is one of several potential treatments for progressive infantile scoliosis. This study reviews our early experience to identify which, if any, patients are likely to benefit from or fail this technique. METHODS: We followed all patients treated at our institutions for progressive infantile scoliosis since 2003 prospectively at 1 institution and retrospectively at the other 2. Data, including etiology, Cobb angles, rib vertebral angle difference, Moe-Nash rotation, and space available for the lung, were recorded over time. RESULTS: Fifty-five patients with progressive infantile scoliosis had more than 1 year of follow-up from the initiation of casting. The diagnosis of progressive scoliosis was made based upon either a progressive Cobb angle or a rib vertebral angle difference of more than 20 degrees at presentation. All but 6 patients responded to cast correction. Nine patients have undergone surgery to date, 6 because of worsening and 3 by parent choice. As shown in the table, initiation of cast correction at a younger age, moderate curve size (<60 degrees), and an idiopathic diagnosis carry a better prognosis than an older age of initiation, curve >60 degrees, and a nonidiopathic diagnosis. The space available for the lung improved from 0.89 to 0.93. No patient experienced worsening of rib deformities. CONCLUSIONS: Serial cast correction for infantile scoliosis often results in full correction in infants with idiopathic curves less than 60 degrees if started before 20 months of age. Cast correction for older patients with larger curves or nonidiopathic diagnosis still frequently results in curve improvement along with improvement in chest and body shape. SIGNIFICANCE: Derotational cast correction seems to play a role in the treatment of progressive infantile scoliosis with cures in young patients and reductions in curve size with a delay in surgery in older and syndromic patients. LEVEL OF EVIDENCE: Level 4, therapeutic study.

    PMID: 19700987 [PubMed - indexed for MEDLINE]

  3. #3
    Join Date
    Jun 2010
    Posts
    1

    similar experience

    We also have Kaiser...our 13 month old was just diagnosed with a 40 degree curve on 6/4; she has an MRI later this week and the plan is to fit for brace wait 3 mos, xray then "possibly" cast...I don't want to wait that long; if I could I'd have her casted today! If you don't mind me asking, where are you getting the Mehta casting done? How long did it take for your child to be accepted for procedure?

    Anyone who has info on where we can go and get started with the Mehta cast would be greatly appreciated

    Sincerely,
    Jennifer

  4. #4
    Join Date
    Aug 2004
    Location
    ny
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    If anyone would like more information on Mehta casting for infantile scoliosis, I strongly urge you to check out www.infantilescoliosis.org. There is a forum full of parents who are currently casting their children, or who have casted their children - many with excellent results.

    I can also put you in touch with the mom who founded ISOP (Infantile Scolioiss Outreach Project) and has been instrumental in bringing the Mehta method of casting to the United States, which as I mentioned, has had great results for many very young children.

    Feel free to e-mail me for her contact info.

    Best of luck,
    Last edited by mariaf; 06-10-2010 at 06:18 AM.
    mariaf305@yahoo.com
    Mom to David, age 15, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently holding around 26 degrees)
    Under care of Dr. Randal Betz since 2004

    Also mom to Nicole (22) and Danny (25)

    Link to VBS Website: www.vertebralstapling.com

    Janet Cerrone, PA to Dr. Betz janetcerrone@spineandscoliosis.com or (609) 912-1500

  5. #5
    Join Date
    Aug 2004
    Location
    ny
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    1,753
    Quote Originally Posted by audreymdawson View Post
    My wife and I have Kaiser Insurance and have known for about a year that our daughter has scoliosis. Her doctor prescribed her to get a TLSO brace and she's been wearing it since September. That is when the curve started progressing. Since then, the curve hasn't stopped and it's now at 58 degrees.
    Just recently we found out about the mehta casting option and she's going to have it done in a week or so.

    Our question is why aren't more Hospitals/Doctor's using this technique to help infantile scoliosis (idiopathic)? Is it because of cost's? The brace is nice because it can be cleaned and removed for baths, but it doesn't seem to serve the purpose of correcting the curve. We don't understand why we weren't informed about this by our doctor. Not that it was a conspiracy or anything. Just can't believe that our doctor didn't recommend or know about it.

    Thanks,
    Nate & Kelly
    Hi Nate & Kelly,

    Then I guess nothing has changed since the time my son was first diganosed in 2000

    To make a long story short, looking back now I realize that he could have been a candidate for casting (not sure how I would have felt about it or if it would have worked, but I would have liked to have been given the option!!).

    I don't know why more doctors don't mention casting, but one reason could be that only a handful of docs in any given area are actually trained in the Mehta method of casting (on the site I just posted above, they have a list of such docs around the country). The mom who founded ISOP has devoted the past several years to changing this and has gone a long way in making Mehta-type casting available to more children.

    Anyway, my son was braced for over three years, which held him (did not correct his curve) - and then when he was almost six years old he had VBS, which did bring some correction for him. Were it not for VBS, he would still be braced 22 hours a day and would have almost definitely needed fusion at some point. So, as I said, it would have been nice to at least have been told about casting when he was diagnosed before the age of two.

    Best of luck to you!
    mariaf305@yahoo.com
    Mom to David, age 15, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently holding around 26 degrees)
    Under care of Dr. Randal Betz since 2004

    Also mom to Nicole (22) and Danny (25)

    Link to VBS Website: www.vertebralstapling.com

    Janet Cerrone, PA to Dr. Betz janetcerrone@spineandscoliosis.com or (609) 912-1500

  6. #6
    Join Date
    Apr 2010
    Posts
    3
    The first ortho we saw didn't know about it either..I think for one not many doctors do it and they probably don't know enough about it to refer out..but second it's costly, they have to purchase a special table, or modify a Risser one, and the doctors have to be trained, and it's a surgical procedure. They might not like the additional risk from the amount of general anestheia required for each procedure, I know our doctor is uneasy about this aspect, unlike bracing, casting is considered a surgical procedure so the children are intubated, IV'd, monitored and it's done as an outpatient surgery, lots of money..plus braces last longer than casts so they are less intensive. However, the "handful" of dr. around the country is quickly becoming more like 2 handfuls..*L* which is a good thing..

    3.5 year old in 4th Metha cast at Boston Childrens
    Began with 46/30/ 21 RVAD after many complications, now @12 in cast

  7. #7
    Join Date
    Aug 2009
    Posts
    1,164
    Here's an article from a doctor at the Riley hospital for Children in Indiana who does casting:

    http://www.indystar.com/article/2011...G25/102200317/

  8. #8
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    ny
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    Quote Originally Posted by vtheartmama View Post
    However, the "handful" of dr. around the country is quickly becoming more like 2 handfuls..*L* which is a good thing..

    3.5 year old in 4th Metha cast at Boston Childrens
    Began with 46/30/ 21 RVAD after many complications, now @12 in cast
    I've often said the same thing about VBS - that the handful of surgeons performing it is now 2 (or maybe even 3) handfuls :-)

    I guess some of the same factors (that were mentioned above) are the cause for the small number of docs offering certain treatment options (cost, lack of knowledge about a particular method, etc.).

    I try to follow as much as I can about casting, but I'm not sure I had heard of anyone at Boston Children's who does it. That is great!! Would you be comfortable sharing which doc it is? If not, it's OK - I understand.

    Best of luck!
    mariaf305@yahoo.com
    Mom to David, age 15, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently holding around 26 degrees)
    Under care of Dr. Randal Betz since 2004

    Also mom to Nicole (22) and Danny (25)

    Link to VBS Website: www.vertebralstapling.com

    Janet Cerrone, PA to Dr. Betz janetcerrone@spineandscoliosis.com or (609) 912-1500

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