Transition to brace after casting for early onset scoliosis may improve quality of life
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Patients treated with casting for early onset scoliosis experienced declines in health-related quality of life that were reversible after transitioning from casting to bracing, according to published results.
“Bracing and casting are effective for early onset scoliosis and if you have a child or a family that is struggling with casting, you could transition to a brace to help them emotionally from a quality of life standpoint without experiencing a detrimental effect of controlling the scoliosis,” Suken A. Shah, MD, vice chair of the department of orthopedic surgery, division chief of the Spine and Scoliosis Center and clinical fellowship director at Nemours Children’s Health in Delaware, told Healio.
Using a multicenter database, Shah and colleagues identified 66 patients with idiopathic early onset scoliosis who were treated with casting followed by bracing and compared Early Onset Scoliosis Questionnaire scores before treatment, after index casting, after transitioning out of cast to brace and at the most recent follow-up. Researchers also compared major curve magnitudes during these time points.
Results showed the major curve magnitude in 57 patients improved from a mean of 33° before treatment to 27° after casting and to 24° at the most recent follow-up. Compared with health related quality of life at pre-index treatment, during brace treatment and at most recent follow-up, researchers found patients had a significant decrease in health related quality of life during casting treatment. Researchers also noted improvement in the parental impact subdomain from the beginning to the end of treatment. Satisfaction also improved from casting to bracing and to the most recent follow-up, according to results.
Because not all patients with idiopathic early onset scoliosis can be treated with a brace, Shah noted that spine surgeons can help families prepare for the difficulties with casting while also providing insight on what they can expect with the transition to a brace.
“[Families] might have to take the pain or the parental burden of your child for about a year while they go through the casting, but then, if they can be successfully transitioned to a brace, your child will do better and your family will do better by the end of the treatment,” Shah said.
Perspective
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This paper provides encouraging results for early onset scoliosis patients that health-related quality of life scores return to baseline after casting. Previous work showed that early onset patients had reduced health-related quality of life during casting and that for idiopathic patients, the outcomes scores did not return to baseline values even after coming out of a cast. These results were challenging for many clinicians, who witness the often-amazing radiographic improvements seen with casting and must convince families that casting is right for their child.
Interestingly, brace wear did not seem to impact health-related quality of life, which is also welcome news because many early onset scoliosis patients spend much of their childhood in a brace. Given high complication rates with growing rods, many surgeons and families prefer a trial of nonoperative treatment with casting and bracing when possible. This work by Jeffrey Henstenburg, MD, and colleagues and the Pediatric Spine Study Group shows that casting is a viable approach and does not permanently impact health-related quality of life.
Reference:
Matsumoto H, et al. Spine Deform. 2020;doi:10.1007/s43390-020-00175-5.
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