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Thread: Casting versus bracing in an infant?

  1. #1
    Join Date
    Jun 2007
    Posts
    16

    Casting versus bracing in an infant?

    My son is almost 11 months and just received his brace yesterday. He's got a 70 degree curve (thoracic) and was diagnosed with congenital scoliosis. (However, his MRI came back clean and without any malformations, so I'm wondering if it's actually idiopathic and, as parents, we're operating under that assumption until his surgeon says otherwise July 3rd.)

    Anyway - I've been reading about serial casting and I'm wondering how it benefits babies better than bracing. Is it the difference of the amount of time in the cast/brace?

    Also, I notice his brace slips down during the day. Can they add shoulder straps? It seems like it would be so easy to do to hold it up on his chest better. They really rub against his thighs.

    Thanks

  2. #2
    Join Date
    Oct 2003
    Location
    Utah
    Posts
    1,010
    Hi,

    Honestly, the brace for your little guy who is very active, doesn't have any other medical issue, is strong and overall healthy is not likely to do much good. The statistics aren't in your favor. Casting is definitely worth a try - as you said, trying anything non-surgical first is best. Even in the worst-case scenario, casting will likely post-pone surgery because casting holds the spine so much better than a brace (there are little ones who have had successful bracing, don't get me wrong). Remember there are risks to anything. Long term casting and bracing has shown to cause malformations in the ribs/chest. In some cases, the ribs stay underdeveloped and soft, which isn't good if the child eventually needs surgical intervention.

    My son, Braydon, is now 12yrs old. He was born with congenital scoliosis (multiple hemivertebrae with contralateral failure of segmentation). Bracing and casting were not options for him. He had fusion surgery at 11months old (same age as your little man). At age 6yrs old, he had VEPTR rods placed. After the VEPTR surgery, his right lung improved in size and capacity by more than 40%. Lung volume and function are things you need to be aware of as he continues to grow. Also body balance - are his neck and pelvis well-aligned? The body does amazing things to try and stay balanced. Even if his curve continues to progress, there is a chance you can buy time by having nature keep a good overall balance. However, a 70 degree curve before age 1yr is not a good prognosis. I'd be happy to share more of our story with you. I still strongly encourage you to visit the Yahoo group Infantile_scoliosis. Dr. Lenke is a great researcher, and a great surgeon for teens and adults with scoliosis. However, I haven't heard very many parents recently who have had their very young children treated successfully by him. He tends to be "old school" and may not be open to the other non-surgical options, just FYI.

    I also encourage you to look at photos of kids who have had treatment for scoliosis (again on the yahoo list, and the infantilescoliosis.org site. Having a curved spine doesn't mean they are automatically wheelchair bound. Braydon doesn't have any physical restrictions - he is a very active and healthy (albeit smaller than normal) 6th grader. Don't give up. You are doing great.
    Carmell
    mom to Kara, idiopathic scoliosis, Blake 19, GERD and Braydon 14, VACTERL, GERD, DGE, VEPTR #137, thoracic insufficiency, rib anomalies, congenital scoliosis, missing coccyx, fatty filum/TC, anal stenosis, horseshoe kidney, dbl ureter in left kidney, ureterocele, kidney reflux, neurogenic bladder, bilateral hip dysplasia, right leg/foot dyplasia, tibial torsion, clubfoot with 8 toes, pes cavus, single umblilical artery, etc. http://carmellb-ivil.tripod.com/myfamily/

  3. #3
    Join Date
    Jun 2007
    Posts
    16
    I've tried to join the yahoogroup now for over two weeks and haven't been approved yet. It's rather frustrating when I really need input before we see him and the other doctors.

    Thank you so much for your advice and input. I'd absolutely love to hear more.

    The thing that concerns me most, I guess, is that there are no doctors locally who are casting and we just can't travel that much (with my husband's job and four other kids to care for on top of it).

    If casting WAS going to help, would we see *some* curvature improvement with the brace, at least?

    Ugh. My head is spinning with all this. I feel like I have so much to learn in such a short amount of time.
    Action Jackson - no brace is going to slow me down!
    Diagnosed with a 70 degree thoracic curve 6/6/07
    MRI on 6/14/07 - comes back clean on 6/15/07
    Brace arrived on 6/20/07
    1st Cast applied by Dr. Mehta 8/1/07 at 70
    Yielded no results, back up to 70 out of cast.
    2nd Cast improved down to 40s, 3rd got us into the 30s, as did cast #4.
    At 20 months, in cast 5, correction isn't being achieved.

  4. #4
    Join Date
    Oct 2003
    Location
    Utah
    Posts
    1,010
    Casting is quite different than bracing. Did Jackson have a cast mold made for his brace? Or is his brace a "shelf" model? Braces don't correct a curve. They try to prevent the curve from progressing.

    Casting is done under general anesthesia so they can stretch the child and get a good horizontal correction of the curve. Then they put the cast on. Then they xray, and if the spine is very flexible (which most infants have-flexible spines) the xray will show a remarkable improvement in the curve. The rotation of the spine has a lot to do with how much correction they can get with casting.

    FYI - they are finding that infants with scoliosis often have an underlying connective tissue disorder (ie, Marfans, Ehlers Danlos, etc.). I'm not sure if there are any scientific documents to prove this, but its obvious that most kids don't have "just" infantile scoliosis. There's usually something medical that contributes to it. However, there are those who "just" have scoliosis as infants. It can, and does, happen.

    I will find Heather for you and see if she overlooked your membership request. Hopefully you'll hear from her soon (unless she's out of town).

    More best wishes coming your way.
    Carmell
    mom to Kara, idiopathic scoliosis, Blake 19, GERD and Braydon 14, VACTERL, GERD, DGE, VEPTR #137, thoracic insufficiency, rib anomalies, congenital scoliosis, missing coccyx, fatty filum/TC, anal stenosis, horseshoe kidney, dbl ureter in left kidney, ureterocele, kidney reflux, neurogenic bladder, bilateral hip dysplasia, right leg/foot dyplasia, tibial torsion, clubfoot with 8 toes, pes cavus, single umblilical artery, etc. http://carmellb-ivil.tripod.com/myfamily/

  5. #5
    Join Date
    Jun 2007
    Posts
    16
    Sorry it took me so long to get back.

    Yes - he had a cast made for his brace. We were told it would only stabilize, not correct. I'm just curious as to how a cast corrects but a brace doesn't (not necessarily directed at you, just a thought).

    We met with the surgeon a couple weeks ago and he is thinking that Jack's curve will progress. However, he wants him to see a geneticist in September. He is concerned there may be something else going on, since he has some facial asymmetry from what we thought was the plagiocephaly, but he said with his "forehead protrusion" he wants him evaluated.

    Other than that, he said not to use the brace as often as it was initially prescribed. He said he doesn't do bracing before age two because, as you mentioned, it can worsen the rib issues. He already has a significant bend in the ribs from what we can see, and we don't know if it's exacerbated by the brace or if it was there to begin with.

    So - we wait.
    Action Jackson - no brace is going to slow me down!
    Diagnosed with a 70 degree thoracic curve 6/6/07
    MRI on 6/14/07 - comes back clean on 6/15/07
    Brace arrived on 6/20/07
    1st Cast applied by Dr. Mehta 8/1/07 at 70
    Yielded no results, back up to 70 out of cast.
    2nd Cast improved down to 40s, 3rd got us into the 30s, as did cast #4.
    At 20 months, in cast 5, correction isn't being achieved.

  6. #6
    Join Date
    Aug 2006
    Location
    Kalispell, MT
    Posts
    9

    Please look into casting...

    Hello,

    Our son Noah was at 80 degrees and 11 month old when we started serial casting. He is currently in his 4th cast and he measures 20 - 25 degrees. His rotation is almost gone and he looks great out of the cast. Casting has corrected his curve by almost 60 degrees!

    You can see most of our story on an earlier post 32 to 80 degrees.... Like you, we did not know what to do but had heard of serial casting. We got into the SLC Shriner program and LOVE it. I cannot imangine where we would be without this program.

    Trust me you can find a way to travel and make this happen. Most local Shriner programs will assist you in travel expenses if you choose to go the Shirner route. Family and friends will pitch in with the other kids, it is worth it!

    Keep us up to date on your situation. I will be glad to talk to you and answer any questions you have and speek to our experience.

  7. #7
    Join Date
    Jun 2007
    Posts
    16
    Thanks!

    We are currently undergoing casting - he is in his second cast and though we saw some correction IN cast, the last one didn't hold. So, we are cautiously optimistic that this one will do more. His curve went from 70 to 25 in this cast, so our fingers are crossed.
    Action Jackson - no brace is going to slow me down!
    Diagnosed with a 70 degree thoracic curve 6/6/07
    MRI on 6/14/07 - comes back clean on 6/15/07
    Brace arrived on 6/20/07
    1st Cast applied by Dr. Mehta 8/1/07 at 70
    Yielded no results, back up to 70 out of cast.
    2nd Cast improved down to 40s, 3rd got us into the 30s, as did cast #4.
    At 20 months, in cast 5, correction isn't being achieved.

  8. #8
    Join Date
    Jan 2006
    Posts
    513
    With your cast, did they do significant cut outs in the chest area for the ribs? I have seen casts like that. I would think that would prevent the deformation caused by bracing.
    I was just interested.

    And why does casting correct, but bracing doesn't?

    Is it because so much more correction can be achieved with casting?
    Is it also because the brace is not 24/7 like a cast?
    Last edited by cherylplinder; 01-10-2008 at 12:34 AM.
    God has used scoliosis to strengthen and mold us. He's good all the time!On this forum these larger curves have not held forever in Spinecor,with an initial positive response followed by deterioration. With deterioration, change treatment.The first year she gained 4 or 5 inches and was stable at around 20/20 in brace, followed by rapid progression the next year.She is now 51/40 (Jan2008)out of brace (40/30 in Spinecor) and started at 38/27 out of brace(Jan2006.) Now in Cheneau.

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