Successful management of idiopathic early-onset scoliosis: effect of curve correction and bracing after Mehta casting

Study design: Patients with idiopathic EOS treated by Mehta casting followed by bracing or observation from a single institution. Objectives: To determine casting protocol parameters leading to successful management; to determine efficacy of bracing vs. observation after cast discontinuance. Background: Previous studies have not precisely defined parameters for cast discontinuance (amount of correction, number of casts), nor have documented the efficacy of brace treatment. Methods: 73 patients undergoing Mehta casting were braced (n = 56) or observed (n = 17) after casting with follow-up for a mean of 51–58 months. 57 patients had ≥ 4 casts applied; 39 had ≥ 5 casts. Success was defined as no further treatment required. Curve magnitude was measured at time points pre-casting, at cast discontinuance, and last follow up. Results: There was no difference in success rate between braced patients (79% success) and observed (71%). Curve correction to < 30° at cast discontinuance was crucial parameter for success, as 95% (45/47) of patients with this correction achieved success, braced or not, while only 42% (11/26) with residual curves ≥ 30° achieved success (p < .001) and 14 of these required surgery compared to 0/47 successful patients. The number of casts (over/under 4 or 5) made no difference in achieving success. 10/26 patients who had residual curves ≥ 30° and were braced achieved success due to further curve diminution during bracing. Conclusions: Cast correction to < 30° followed by bracing achieved 100% success in 34 patients compared to 85% (13 patients) who were observed (p = .07). For residual curves ≥ 30° bracing can produce some correction and succeed in delaying further treatment.