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The role of bracing, casting, and vertical expandable prosthetic titanium rib for the

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  • The role of bracing, casting, and vertical expandable prosthetic titanium rib for the

    J Neurosurg Spine. 2009 Jul;11(1):3-8.Click here to read Links
    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.
    Smith JR, Samdani AF, Pahys J, Ranade A, Asghar J, Cahill P, Betz RR.

    Shriners Hospital for Children, Philadelphia, Pennsylvania.

    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.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  • #2
    So it sounds like casting does work for some parients. Very interesting!!!!


    • #3
      Casting absolutey works! The best candidates are children under the age of 3and it works best if you cast before it gets to 50 degrees. Ian spent 2 years in serial casts and one brace. He started at 43 degrees and the xray this week was around 7 degrees. He has been brace and cast free for over a year and a half.
      Last edited by IansMommy; 09-06-2009, 09:35 PM.


      • #4
        What wonderful news for your son! I keep reading about those casting stories...what a wonderful treatment that was developed by a truly concerned and gifted scoliosis specialist. Min Mehta, I believe.


        • #5
          Yes, Miss Mehta examined Ian prior to his first casting at a conference. She did not personally cast him, but recommended that he be casted by the doctor at Shriners. She's a pretty amazing woman.