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Doctors who Cast Infant/Young Children for Progressive Infantile Idiopathic Scoliosis

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  • #16
    Risser Cast

    Hi Toni.
    I dont really know the difference in casts. I was in Minerver casts from age four solid plaster, very heavy with no openings with neck extension and slight head tilt


    • #17
      after all, they are applied on a Risser-Cotrel frame,

      Actually, the Mehta casts are not applied on a Risser-Cotrel frame. They are applied on an AMIL frame specificallly designed for infants and children whereas the cotrel frames are for adults and therefore are not as effective for small children. The mehta style casts have the mushroom designed cutouts to prevent chestwall deformities as well as the hole that is in the back. The hole in the back allows the flattened ribs to go back in to the more "normal" shape while the cast helps to reduce the rib hump.



      • #18
        Thanks IansMommy, that is very helpful information!

        I assumed that Mehta casts were applied on the Risser-Cotrel frame because at the Royal National Orthopaedic Hospital in Stanmore, where Miss Mehta was based before she retired, they only have that sort of frame and all children are cast upon it. I was cast on it over twenty years ago and they still use it today - I have a young friend who has been undergoing serial casting and she is also cast on the same frame.

        Have you any idea how the AMIL frame differs from the Risser-Cotrel frame please? I don't understand how it would make any difference whether the R-C frame is used for a child or for an adult. From what I have found on the net, the AMIL frame is a relatively new invention but I know Miss Mehta has been doing serial casting of infants as far back as 1977. Maybe the AMIL frame was just created to be more convenient as it is child-sized?

        It sounds like the main difference between a Mehta cast and the R-C cast is that there are cutouts at the back to allow for ribcage expansion, but not all children I know who are undergoing serial casting have these, so I am confused again!

        Thanks for your help!

        Toni xx
        Last edited by tonibunny; 07-27-2007, 04:06 AM.


        • #19
          From what I was told, the adult sized frames don't have the capabilities to properly elongate, or derotate, and holding the infant in traction for optimal correction. I don't know physically how they differ, but I can find out for you and let you know.

          If I remember correctly from her study, Mehta did start out using adult sized frames, but then found that the frame designed for a child yielded her better results.

          She actually has examined my son and she was/is using the AMIL frame when she casted.


          • #20
            That's excellent news I think Min Mehta is amazing - I met her a few times when I was being treated at Stanmore in the 70s and 80s.

            It sounds like serial casting can be done on a R-C frame, but the new AMIL frame is much preferable. Can you describe it for us? It would be interesting to know how they differ, so thanks for offering to find out

            I wasn't given a general anaesthetic when I was cast as a child so I can remember the whole was uncomfortable rather than painful for me, though they pushed and pulled me about a lot. Most other kiddies my age did have GAs for their casting but I was well known for just shutting up and putting up with it. I remember always feeling like I might fall off the thin strip of canvas that I was lying on, except my head and feet were in traction!


            • #21
              I haven't seen the table. Ian is always under anesthesia when they do the casting, so I am not in the room when they do it although I would have loved to have been in there to see exactly what they do!

              I will try to find out for you what it looks like...I know that it is smaller, but other than that I am not sure.

              I quick glanced at her article and she did use the Cotrel table although I know she uses the AMIL table now.

              The doctor who was treating Ian left Shriners to go to another hospital. They were trying to purchase the AMIL frame for the hospital that he was moving to, but were having trouble getting it (I think problems with the manufacturer). He told me he felt he could modify the table they had until they could get the AMIL. I never thought to ask what sort of changes would be needed.

              I wonder if there are any pictures of it out there? I tried to google the AMIL table and could not find anything. I do remember finding something on it several months ago, but it was mostly in a foreign language (german maybe?). I'm asking around though. I'll let you know when I find out exactly what the differences are.


              • #22
                Originally posted by IansMommy
                From what I was told, the adult sized frames don't have the capabilities to properly elongate, or derotate, and holding the infant in traction for optimal correction.
                Hi Jennifer

                Who told you this? Deirdre was not cast on an AMIL frame at 19 months of age and yet her curve was reduced from 68 degrees to 8 incast with serial casting before going into the Spinecor which further reduced her curve to 1 degree. Dr. Sanders was casting young children at the Shriners in Erie for two years before getting the AMIL frame with equally good results so I don't understand.

                Canadian eh
                Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008


                • #23
                  I learned about the AMIL frame when Ian was participated in the ETP conference headed by Mehta. The conference was held at the Shriners in Erie, PA and doctors from all different parts of the country participated either in person or via teleconferencing. (Mehta will be in Chicago in a few weeks for another ETP by the way).

                  Okay, this is my understanding of the differences. The Striker and Risser frames do not have a traction mechanism or derotation ability and therefore cannot correct the scoliosis 3 dimensionally. The Cotrell frames do have these abilities, but infants are too small for the huge frame to get the best results.

                  When we saw Mehta, she told me that even though Ian's RVAD was borderline (21 degrees) she was certain that he would progress due to the significant amount of rotation he had (45 degrees). She told me she had never seen that much rotation with a Cobb angle as low as what Ian had (36 degrees). She would have expected a much more severe curve. Anyway, she was right and when the new films were taken he was 43 degrees.

                  The thing I learned there was how significant the rotation is. Basically, what I learned is that if the rotation is not addressed, you are treating the effect and not the cause.

                  Anyway, I am not wanting to debate...just sharing what I know about the AMIL frame and our experience with it. I'm glad Deirdre is doing so well. I have heard good things about the Spinecor.

                  Ian is now straight and we finished casting back in May. He's in a brace and doing well.
                  Last edited by IansMommy; 07-28-2007, 05:11 PM.


                  • #24
                    Hi Jennifer,

                    Was it dr. Mehta that told you the AMIL frame is absolutely necessary for young children? If so, I don't understand why Deirdre did so well without it. For all intents and purposes she shouldn't be straight, right? It's quite a stretch of the imagination to think that doctors in the U.S. can go to medical school for countless years and yet not know how to apply a basic torso cast ?! This doesn't say very much about U.S. doctors, does it? They are after all, specialists in orthopaedics????! Why create these artificial barriers to treatment? This is an absolute joke! Are we to believe that all the doctors who have written articles on serial casting or have successfully treated children with progressive infantile scoliosis were personally trained by Min Mehta?? What about people who can't travel long distances for treatment because of financial constraints or family obligations? Do these children just fall through the cracks? Obviously they do AND they are... I find it odd that Dr. Mehta would be summoned given her frail health to travel clear across the Atlantic Ocean to teach these doctors a basic cast technician technique!!! However, I'm not surprised given her generous nature and wonderful character that she would donate her time freely over and again if requested to do so, to a cause such as infantile scoliosis despite her age and failing health.

                    By the way, I'm sooooo happy for Ian and especially for you !!!! What is his in brace curve now ?
                    Last edited by Celia; 08-14-2007, 09:53 PM.

                    Canadian eh
                    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008


                    • #25
                      Another Name to Add to the List

                      I recently learned that Dr. John Asghar at Shriners Hospital for Children in Philadelphia does serial casting on infants and young children as well. He can be reached at 1-800-281-4050. He informed me that he, along with Dr. D'Andrea, learned the technique from Dr. Mehta and that it is becoming an increasingly large part of his practice. Dr. Asghar also happens to have a great bedside manner.
                      Mom to David, age 17, braced June 2000 to March 2004
                      Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)




                      • #26
                        And another - Dr. Albert Sanders at Christus Santa Rosa in San Antonio, TX.
                        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.


                        • #27
                          Boston Childrens

                          Boston Children's is also doing serial casting for scoliosis. They are using a modified Risser frame to the best of my knowledge. The drs. are not as experienced with it but time will help and they are learning from other casting doctors..yes they are using the Metha method with the mushroom cutouts, they call them Risser casts though and bill them as Risser casts because insurance will not cover them for some of you who are confused about the difference in name, much of it is simply for insurance purposes (disclaimer: still check w/ your doctor though).